Indications for and Risks of Noninvasive Respiratory Support

Abstract

Within the last decades, therapeutic advances have significantly improved the survival of extremely preterm infants. In contrast, the incidence of major neonatal morbidities, including bronchopulmonary dysplasia, has not declined. Given the well-established relationship between exposure to invasive mechanical ventilation and neonatal lung injury, neonatologists have sought for effective strategies of noninvasive respiratory support in high-risk infants. Continuous positive airway pressure has replaced invasive mechanical ventilation for the initial stabilization and the treatment of respiratory distress syndrome. Today, noninvasive respiratory support has been adopted even in the tiniest babies with the highest risk of lung injury. Moreover, different modes of noninvasive respiratory support supplemented by a number of adjunctive measures and rescue strategies have entered clinical practice with the goal of preventing intubation or reintubation. However, does this unquestionably important paradigm shift to strategies focused on noninvasive support lull us into a false sense of security? Can we do better in (i) identifying those very immature preterm infants best equipped for noninvasive stabilization, can we improve (ii) determinants of failure of noninvasive respiratory support in the individual infant and underlying etiology, and can we enhance (iii) success of noninvasive respiratory support and (iv) better prevent ultimate harm to the developing lung? With increased survival of infants at the highest risk of developing lung injury and an unchanging burden of bronchopulmonary dysplasia, we should question indiscriminate use of noninvasive respiratory support and address the above issues.

Evaluation of nursing care requirements in mechanically ventilated patients

“…Mechanical ventilation [MV] is a frequently used method to relieve respiratory muscles in patients with acute respiratory failure and to reduce the workload, especially in intensive care units [1,2].…”

Sharing Progress in Neonatology (SPIN): Oxygen and Surfactant, Optimal Ventilation, Pulmonary Hypertension, Diagnostic Procedures, and Definition of Bronchopulmonary Dysplasia

“…Clyde Wright from Denver, CO, USA, talked about the indications and risks associated with noninvasive respiratory support [24]. Continuing high rates of BPD have prompted neonatologists to look for effective noninvasive strategies for high-risk infants to avoid the harmful effects of invasive ventilation [25].…”

“…"Is it possible to better identify very preterm infants who are best equipped for non-invasive respiratory support?" [24]. Surfactant deficiency is probably the commonest cause of CPAP failure, and it is important to diagnose it early so that surfactant treatment is not unduly delayed.…”

“…Surfactant deficiency is probably the commonest cause of CPAP failure, and it is important to diagnose it early so that surfactant treatment is not unduly delayed. This may require improved diagnostic tests for surfactant deficiency and use of lung ultrasound [24]. Another important development is LISA [17] which allows surfactant administration without endotracheal intubation [24].…”

“…This may require improved diagnostic tests for surfactant deficiency and use of lung ultrasound [24]. Another important development is LISA [17] which allows surfactant administration without endotracheal intubation [24]. Finally, there is a paucity of long-term follow-up data on very preterm infants treated with noninvasive respiratory support and this needs to be remedied before accepting that "one size fits all" [24].…”