Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants

Pantalitschka, T.; Sievers, Jule; Urschitz, Michael S.; Herberts, Tina; Reher, Claudia; Poets, Christian F.

doi:10.1136/adc.2008.148981

Cited by 79 publications

(55 citation statements)

References 30 publications

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“…Apnea of prematurity is a common problem in preterm infants which can be treated with NCPAP and NIPPV [30]. As it is unclear whether SNIPPV would be even more effective in treating apnea, we conducted a clinical trial to assess the effects of NCPAP, NIPPV and flow-SNIPPV on rates of desaturations and bradycardias in VLBW infants and to evaluate the influence of these modes of ventilation on pattern of breathing and gas exchange [31].…”

Section: Clinical Results With Snippvmentioning

confidence: 99%

Synchronized Nasal Intermittent Positive Pressure Ventilation of the Newborn: Technical Issues and Clinical Results

et al. 2016

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Although mechanical ventilation via an endotracheal tube has undoubtedly led to improvement in neonatal survival in the last 40 years, the prolonged use of this technique may predispose the infant to development of many possible complications including bronchopulmonary dysplasia. Avoiding mechanical ventilation is thought to be a critical goal, and different modes of noninvasive respiratory support beyond nasal continuous positive airway pressure, such as nasal intermittent positive pressure ventilation and synchronized nasal intermittent positive pressure ventilation, are also available and may reduce intubation rate. Several trials have demonstrated that the newer modes of noninvasive ventilation are more effective than nasal continuous positive airway pressure in reducing extubation failure and may also be more helpful as modes of primary support to treat respiratory distress syndrome after surfactant and for treatment of apnea of prematurity. With synchronized noninvasive ventilation, these benefits are more consistent, and different modes of synchronization have been reported. Although flow-triggering is the most common mode of synchronization, this technique is not reliable for noninvasive ventilation in neonates because it is affected by variable leaks at the mouth and nose. This review discusses the mechanisms of action, benefits and limitations of noninvasive ventilation, describes the different modes of synchronization and analyzes the technical characteristics, properties and clinical results of a flow-sensor expressly developed for synchronized noninvasive ventilation.

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Section: Clinical Results With Snippvmentioning

confidence: 99%

Synchronized Nasal Intermittent Positive Pressure Ventilation of the Newborn: Technical Issues and Clinical Results

et al. 2016

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“…41 It is not clear as yet if nasal intermittent positive pressure ventilation and nasal flow-synchronized intermittent positive pressure ventilation (nSIPPV), generally used with a peak inspiratory pressure of 15-20 cm H 2 O and a positive end-expiratory pressure of 5-6 cm H 2 O, is more effective then nCPAP in treating AOP. However, reductions in apneic episodes and mechanical ventilation requirements due to AOP along with a need for lower caffeine doses have been seen with nSIPPV.…”

Section: Noninvasive Ventilation Supportmentioning

confidence: 99%

Apnea of prematurity: challenges and solutions

Picone¹,

Aufieri²,

Paolillo³

2014

RRN

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Apnea of prematurity is a developmental disorder that frequently affects preterm infants, especially those with lower gestational age. Even if apnea of prematurity is by definition a self-limiting condition, it can cause serious problems during the hospital stay and can potentially have long-term neurological and cognitive consequences depending on the severity and intensity of the episodes. The diagnosis of apnea of prematurity can be made only after excluding a number of diseases of the preterm infant in which apnea may be an epiphenomenon. Etiological diagnosis is essential for selection of appropriate treatment, which may be nonpharmacological or involve use of drugs.

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“…Two studies reported no differences in oxygenation or CO 2 levels [12,35] between NCPAP and SNIPPV. One reported better oxygenation with NCPAP [48], whilst a fourth reported better oxygenation and carbon dioxide during SNIPPV, compared with NCPAP [47]. One study of nsNIPPV found lower CO 2 levels but no difference in O 2 levels compared to CPAP [49].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…The clinical significance of these contrasting findings is unclear. A crossover study comparing two modes of nsNIPPV (ventilator and IFDa) with two modes of NCPAP (IFDa and ‘bubble CPAP') in 16 preterm infants also found no difference in apnoea number between modes [48]. A Cochrane review including the studies by Lin and Ryan concluded that NIPPV may augment the effects of NCPAP in apnoea that is frequent or severe, but only short-term effects were studied, and more data are required before NIPPV could be recommended as a therapy for apnoea [51].…”

Section: Use Of Non-invasive Respiratory Support In Specific Clinicalmentioning

confidence: 99%

Neonatal Non-Invasive Respiratory Support: Synchronised NIPPV, Non-Synchronised NIPPV or Bi-Level CPAP: What Is the Evidence in 2013?

2013

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Nasal continuous positive airway pressure (NCPAP) has proven to be an effective mode of non-invasive respiratory support in preterm infants; however, many infants still require endotracheal ventilation, placing them at an increased risk of morbidities such as bronchopulmonary dysplasia. Several other modes of non-invasive respiratory support beyond NCPAP, including synchronised and non-synchronised nasal intermittent positive pressure ventilation (SNIPPV and nsNIPPV) and bi-level positive airway pressure (BiPAP) are now also available. These techniques require different approaches, and the exact mechanisms by which they act remain unclear. SNIPPV has been shown to reduce the rate of reintubation in comparison to NCPAP when used as post-extubation support, but the evidence for nsNIPPV and BiPAP in this context is less convincing. There is some evidence that NIPPV (whether synchronised or non-synchronised) used as primary respiratory support is beneficial, but the variation in study methodology makes this hard to translate confidently into clinical practice. There is currently no evidence to suggest a reduction in mortality or important morbidities such as bronchopulmonary dysplasia, with NIPPV or BiPAP in comparison to NCPAP, and there is a lack of appropriately designed studies in this area. This review discusses the different approaches and proposed mechanisms of action of SNIPPV, nsNIPPV and BiPAP, the challenges of applying the available evidence for these distinct modalities of non-invasive respiratory support to clinical practice, and possible areas of future research.

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Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants

Abstract: A variable flow NCPAP device may be more effective in treating AOP in preterm infants than a conventional ventilator in NIPPV mode. It remains unclear whether synchronised NIPPV would be even more effective.

Cited by 79 publications

References 30 publications

Synchronized Nasal Intermittent Positive Pressure Ventilation of the Newborn: Technical Issues and Clinical Results

Synchronized Nasal Intermittent Positive Pressure Ventilation of the Newborn: Technical Issues and Clinical Results

Apnea of prematurity: challenges and solutions

Neonatal Non-Invasive Respiratory Support: Synchronised NIPPV, Non-Synchronised NIPPV or Bi-Level CPAP: What Is the Evidence in 2013?

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