High CPAP vs. NIPPV in preterm neonates — A physiological cross-over study

Mukerji, Amit; Wahab, Muzafar Gani Abdul; Razak, Abdul; Rempel, Emily; Patel, Waseemoddin; Mondal, Tapas; Beck, Jennifer

doi:10.1038/s41372-021-01122-6

Cited by 9 publications

(11 citation statements)

References 17 publications

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“…Baseline and demographic variables are shown in ►Table 1. The initial postextubation median (IQR) CPAP pressure levels were 13 (12)(13)(14) and 10 (10-12) cm H 2 O, while the preextubation median Paw were 10 (10-12) and 11 (10)(11)(12) cm H 2 O in the higher CPAP and equivalent CPAP groups, respectively. A higher proportion of babies in the higher CPAP group were treated with systemic steroids for bronchopulmonary dysplasia (BPD) prior to extubation (48 vs. 26%).…”

Section: Resultsmentioning

confidence: 95%

“…Baseline and demographic variables are shown in Table 1. The initial post-extubation median (IQR) CPAP pressure levels were 13 (12)(13)(14) and 10 (10-12) cmH 2 O, while the pre-extubation median Paw were 10 (10-12) and 11 (10-12) cmH 2 O in the Higher CPAP and Equivalent CPAP groups, respectively.…”

Section: Resultsmentioning

confidence: 96%

“…In fact, the findings of Cochrane review that suggest superiority of NIPPV vs. CPAP as a postextubation support mode may relate simply to the fact that the mean Paw delivered during NIPPV was higher than with CPAP (13). A physiological cross-over study demonstrated no differences in left or right ventricular cardiac output or work of breathing indices when comparing high CPAP and NIPPV at equivalent mean Paw (12). A pilot clinical trial comparing NIPPV and high CPAP (≥9 cmH 2 O) is currently underway (NCT03512158).…”

Section: Comparison To Previous Literaturementioning

confidence: 99%

“…A Canadian survey from 2016 demonstrated that 7 out of 28 centres utilized CPAP levels >8 cmH 2 O, with 5 of them reporting use of 10 cmH 2 O or higher (5). While NIPPV remains the NRS modality of choice at most centres after failure of traditional CPAP levels (8 cmH 2 O), emerging data suggests that high CPAP -especially if used at equivalent mean airway pressures -may be a suitable alternative (8,12). In fact, the findings of Cochrane review that suggest superiority of NIPPV vs. CPAP as a postextubation support mode may relate simply to the fact that the mean Paw delivered during NIPPV was higher than with CPAP (13).…”

Section: Comparison To Previous Literaturementioning

confidence: 99%

“…5 While NIPPV remains the NRS modality of choice at most centers after failure of traditional CPAP levels (8 cm H 2 O), emerging data suggest that high CPAP, especially if used at equivalent mean airway pressures, may be a suitable alternative. 8,12 In fact, the findings of Cochrane review that suggest superiority of NIPPV versus CPAP as a postextubation support mode may relate simply to the fact that the mean Paw delivered during NIPPV was higher than with CPAP. 13 A physiological cross-over study demonstrated no differences in left or right ventricular cardiac output or work of breathing indices when comparing high CPAP and NIPPV at equivalent mean Paw.…”

Section: Comparison To Previous Literaturementioning

confidence: 99%

See 4 more Smart Citations

Toward Optimal High Continuous Positive Airway Pressure as Postextubation Support in Preterm Neonates: A Retrospective Cohort Study

Khalid¹,

Albalushi²,

Manoj³

et al. 2022

Am J Perinatol

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Objective: To evaluate whether the initial pressure level on High CPAP (≥9 cmH2O), in relation to pre-extubation mean airway pressure (Paw), influences short-term clinical outcomes in preterm neonates. Design/Methods: In this retrospective-cohort study, preterm neonates <29 weeks’ gestational age (GA) extubated from mean Paw ≥9 cmH2O and to High CPAP (≥9 cmH2O) were classified into “Higher-level CPAP” (2-3 cmH2O higher than pre-extubation Paw) and “Equivalent CPAP” (-1 to +1 cmH2O in relation to pre-extubation Paw). Only the first eligible extubation per infant was analyzed. The primary outcome was failure within ≤7 days of extubation, defined as any one or more of: (a) need for re-intubation, (b) escalation to an alternate non-invasive respiratory support mode, or (c) use of CPAP >pre-extubation Paw +3 cmH2O. Secondary outcomes included individual components of the primary outcome, along with other clinical and safety outcomes. Results: Over a 10 year period (Jan 2011 to Dec 2020), 175 infants were extubated from mean Paw >9 cmH2O to High CPAP pressures. Twenty-seven subjects [median (IQR) GA 24.7 (24.0-26.4) weeks and chronological age 31 (21-40) days] were classified into the “Higher-level CPAP” group while 148 infants [median (IQR) GA 25.4 (24.6-26.6) weeks and chronological age 26 (10-39) days] comprised the “Equivalent CPAP” group. There was no difference in the primary outcome (44% vs. 51%; P=0.51), including post-adjustment for confounders (adjusted OR 0.47 [95% CI 0.17-1.29; P=0.14]). However, re-intubation risk within 7 days was lower with Higher-level CPAP (7% vs. 37%; P<0.01), including post-adjustment (aOR 0.07; 95% CI 0.02-0.35; P<0.01). Conclusions: In this cohort, use of initial distending CPAP pressures 2-3 cmH2O higher than pre-extubation Paw did not alter the primary outcome of failure, but did lower the risk of re-intubation. The latter is an interesting hypothesis-generating finding that requires further confirmation.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 96%

Section: Comparison To Previous Literaturementioning

confidence: 99%

Section: Comparison To Previous Literaturementioning

confidence: 99%

Section: Comparison To Previous Literaturementioning

confidence: 99%

See 3 more Smart Citations

Toward Optimal High Continuous Positive Airway Pressure as Postextubation Support in Preterm Neonates: A Retrospective Cohort Study

Khalid¹,

Albalushi²,

Manoj³

et al. 2022

Am J Perinatol

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A physiological approach to applying CPAP in the preterm infant

Polin

Sahni

2023

The Anatomical Record

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Nasal continuous positive airway pressure (CPAP) is increasingly used for respiratory support in preterm infants with respiratory distress syndrome at birth and after extubation from mechanical ventilation. Controversies with CPAP use still exists due to non‐uniformity of devices and interfaces used, equivalence of testing conditions for different CPAP systems, differences in study designs, and short study periods that may be insufficient to detect important and relevant clinical outcomes. Compared with ventilator‐derived constant‐pressure flow‐opposition CPAP, variable fluidic flow‐opposition CPAP systems may be advantageous and offer some clinical benefits. The distinction between constant‐flow fluid‐sealed bubble CPAP and variable‐flow fluidic flow‐opposition systems is less clear. Appropriately designed randomized clinical trials that separately address the controversies with CPAP use in various clinical settings, are necessary to determine which CPAP system results in best outcomes.

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State of the art on neonatal noninvasive respiratory support: How physiological and technological principles explain the clinical outcomes

Lavizzari

Zannin

Klotz

et al. 2023

Pediatric Pulmonology

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Noninvasive respiratory support has gained significant popularity in neonatal units because of its potential to reduce lung injury associated with invasive mechanical ventilation. To minimize lung injury, clinicians aim to apply for noninvasive respiratory support as early as possible. However, the physiological background and the technology behind such support modes are not always clear, and many open questions remain regarding the indications of use and clinical outcomes. This narrative review discusses the currently available evidence for various noninvasive respiratory support modes applied in Neonatal Medicine in terms of physiological effects and indications. Reviewed modes include nasal continuous positive airway pressure, nasal high‐flow therapy, noninvasive high‐frequency oscillatory ventilation, nasal intermittent positive pressure ventilation (NIPPV), synchronized NIPPV and noninvasive neurally adjusted ventilatory assist. To enhance clinicians’ awareness of each support mode's strengths and limitations, we summarize technical features related to the functioning mechanisms of devices and the physical properties of the interfaces commonly used for providing noninvasive respiratory support to neonates. We finally address areas of current controversy and suggest possible areas of research for implementing noninvasive respiratory support in neonatal intensive care units.

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High CPAP vs. NIPPV in preterm neonates — A physiological cross-over study

Cited by 9 publications

References 17 publications

Toward Optimal High Continuous Positive Airway Pressure as Postextubation Support in Preterm Neonates: A Retrospective Cohort Study

Toward Optimal High Continuous Positive Airway Pressure as Postextubation Support in Preterm Neonates: A Retrospective Cohort Study

A physiological approach to applying CPAP in the preterm infant

State of the art on neonatal noninvasive respiratory support: How physiological and technological principles explain the clinical outcomes

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