RAM cannula versus short binasal prongs for nasal continuous positive airway pressure delivery in preterm infants: a randomized, noninferiority trial from low-middle-income country

Samim, S K; Debata, Pradeep; Yadav, Amita; Kumar, Jogender; Anand, Pratima; Garg, Mukesh

doi:10.1007/s00431-022-04620-7

Cited by 9 publications

(6 citation statements)

References 28 publications

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“…The convenient fixation of a RAM cannula provides comfort for both neonates and caregivers. Studies have found that the RAM cannula causes fewer nasal injuries; secondary outcomes such as these support the RAM cannula as a more comfortable interface 14,22 . Uncomfortable infants may have increased heart rate and breathing rate due to increased sympathetic activation 9,10 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of two different Nasal Interfaces used in Non-Invasive Respiratory support in terms of Neonate comfort

Deveci,

Dag,

Alagoz

et al. 2024

Mal. Med. J

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Background Non-Invasive Ventilation (NIV) is the first choice approach in neonates with sufficient respiratory effort that require respiratory support. The type of nasal interface used in NIV affects both efficacy and patient comfort. The aim of this study is to investigate the effects of different nasal interfaces used in NIV support on neonatal patient comfort.MethodsOur study evaluated patients who received NIV support for 24 hours. The patients were randomly divided into two groups according to the type of nasal interface used, which were RAM cannula and short binasal prong (SBP). The patients’ demographic and clinical data were noted. Their sleep was monitored for 24 hours with an actigraphy device.ResultsA total of 82 patients were evaluated. The sleep efficiency in the RAM cannula group was significantly higher (respectively, 65.7% [10.22-95.25] vs. 57.81% [2.49-77], p=0.004). Although not statistically significant, the neonates in the RAM cannula group exhibited longer total sleep time (respectively, 10.4 ± 4.28 hours vs. 9.02 ± 3.73 hours, p=0.161). Comparison of heart rates and respiratory rates indicate that the patients in the RAM cannula group were more comfortable.Conclusions Our study found that infants who received NIV support through a RAM cannula experienced more efficient sleep. Holistic approaches in neonatal intensive care units are vital for better neurodevelopmental outcomes in newborns. Although non-invasive, the interface used in NIV should also be a part of this holistic approach.

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Section: Discussionmentioning

confidence: 99%

Comparison of two different Nasal Interfaces used in Non-Invasive Respiratory support in terms of Neonate comfort

Deveci,

Dag,

Alagoz

et al. 2024

Mal. Med. J

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“…Studies have demonstrated the utility of NIV via the RAM cannula in infants with prematurity hospitalized in the neonatal ICU and for escalation and de-escalation of respiratory support in the cardiac ICU. 4 , 5 , 9 De Jesus Rojas et al 10 reported a retrospective study of 18 children (mean age 7 ± 6.3 years) who used outpatient NIV via the RAM cannula for an average duration of 8.4 months. Similar to our study, patients had a variety of underlying diagnoses such as OSA, Trisomy 21, and RLDs and used the RAM cannula due to intolerance of conventional interfaces, to reduce dyspnea, and to avoid tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…In neonatal ICUs, NIV is widely utilized for the respiratory management of preterm infants with respiratory distress syndrome and bronchopulmonary dysplasia (BPD). 5,6 Additionally, NIV is being increasingly used in infants and children for the outpatient management of sleep-disordered breathing, respiratory control disorders, neuromuscular diseases, and chronic respiratory failure. [1][2][3]7,8 The interfaces used for outpatient NIV include nasal, oro-nasal, nasal pillows, and total face masks.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 The RAM cannula consists of soft and flexible nasal prongs to administer supplemental oxygen and NIV in infants and children. 5,6,9,10 In a lung simulator model, an appropriately sized RAM cannula resulted in transmission of 60% to 70% of the ventilator set inspiratory and expiratory pressures. 6 In contrast to short binasal prongs, a popular interface to deliver nasal CPAP in infants in the neonatal ICU, the risk for nasal trauma was lower with the RAM cannula.…”

Section: Introductionmentioning

confidence: 99%

“… 6 In contrast to short binasal prongs, a popular interface to deliver nasal CPAP in infants in the neonatal ICU, the risk for nasal trauma was lower with the RAM cannula. 5 Since the RAM cannula covers a smaller area of the face in contrast to conventional NIV masks, it could be better tolerated in infants and children requiring NIV. 10 , 11 Although the RAM cannula has been used in the inpatient setting and ICUs, there is limited literature regarding the safety, efficacy, and long-term outcomes of children using the RAM cannula for outpatient NIV.…”

Section: Introductionmentioning

confidence: 99%

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Outpatient Utilization of the RAM Cannula for Nasal Noninvasive Ventilation in Children

Truitt,

Kallam,

Price

et al. 2023

Clin Med Insights Pediatr

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Background: The RAM cannula® consists of nasal prongs that can be used to administer oxygen, continuous, and bilevel positive airway pressure therapies. Studies have reported the efficacy and utility of the RAM cannula in inpatients requiring noninvasive ventilation (NIV); however, there is limited literature on the use of the RAM cannula to provide NIV in the outpatient setting. Objectives: This study aimed to describe the clinical features and outcomes of children who used NIV via RAM cannula in the outpatient setting. Design: Retrospective review. Methods: We conducted a retrospective review of children treated with outpatient NIV via RAM cannula at our institution between January 2010 and March 2023. The analyzed data included age, diagnoses, indications for NIV, duration of RAM cannula use, complications, and outcomes at 6 months. Results: We identified 20 patients who used outpatient NIV via RAM cannula during the study period. The median age at initiation of NIV via RAM cannula was 5.8 months (IQR 2.4-9.9 months). Indications for NIV included sleep-related hypoventilation (15%), restrictive lung disease (25%), obstructive sleep apnea (45%), and chronic respiratory failure (50%), with 6 patients having ⩾2 indications for NIV. RAM cannula was utilized for inability to tolerate conventional NIV interfaces (80%), to alleviate dyspnea (60%), and to avoid tracheostomy (55%). Patients used NIV via RAM cannula for a median duration of 7.7 months (IQR 3.7-20.6 months). Patient outcomes included ongoing usage of RAM cannula (55%), changing to conventional NIV interfaces (15%) or oxygen (10%), weaning off respiratory support (5%), and death (15%). There were no complications related to using the RAM cannula. Conclusion: Our study demonstrates the utility of outpatient NIV via RAM cannula in children with a variety of diagnoses until clinical improvement or tolerance of conventional interfaces, and for avoidance of tracheostomy.

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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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RAM cannula versus short binasal prongs for nasal continuous positive airway pressure delivery in preterm infants: a randomized, noninferiority trial from low-middle-income country

Cited by 9 publications

References 28 publications

Comparison of two different Nasal Interfaces used in Non-Invasive Respiratory support in terms of Neonate comfort

Comparison of two different Nasal Interfaces used in Non-Invasive Respiratory support in terms of Neonate comfort

Outpatient Utilization of the RAM Cannula for Nasal Noninvasive Ventilation in Children

A physiological approach to applying CPAP in the preterm infant

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