Synchronized Nasal Intermittent Positive-Pressure Ventilation and Neonatal Outcomes

Bhandari, Vineet; Finer, Neil N.; Ehrenkranz, Richard A.; Saha, Shampa; Das, Abhik; Walsh, Michele C.; Engle, William A.; VanMeurs, Krisa P.

doi:10.1542/peds.2008-1302

Cited by 88 publications

(63 citation statements)

References 49 publications

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“…Furthermore, ventilator-associated pneumonia may contribute to the ongoing inflammation in the lung, eventually leading to BPD. Three studies 21,24,25 suggest that early extubation to NIPPV may be an important modifier of BPD, even if the total duration of mechanical ventilation is not different. In a large retrospective study, Bhandari et al 24 reported that use of sNIPPV was associated with decreased BPD, BPD/death, neurodevelopmental impairment and neurodevelopmental impairment/death when compared with infants managed on NCPAP.…”

Section: Discussionmentioning

confidence: 99%

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

et al. 2012

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Objective: To compare the effect of early extubation to nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) on the need for mechanical ventilation via endotracheal tube (MVET) at 7 days of age in preterm infants <30 weeks' gestation requiring intubation and surfactant for respiratory distress syndrome (RDS) within 60 min of delivery.Study Design: Multicenter, randomized, controlled trial. A total of 57 infants were randomized within 120 min of birth to NCPAP (BW 1099 g and GA 27.8 weeks) and 53 infants to NIPPV (BW 1052 g, and GA 27.8 weeks). Infants were stabilized on NCPAP at birth and were given poractant alfa combined with MVET within 60 min of age. When stabilized on MVET, they were extubated within the next hours or days to NCPAP or NIPPV.Result: A total of 40% of infants needed MVET at 7 days of age in the NCPAP group compared with 17% in the NIPPV group (OR: 3.6; 95% CI: 1.5, 8.7). Days on MVET were 12±11 days in NCPAP group compared with 7.5 ± 12 days in the NIPPV group (median 1 vs 7 days; P ¼ 0.006). Clinical bronchopulmonary dysplasia (BPD) was 39% in the NCPAP group compared to 21% in the NIPPV group (OR: 2.4; 95% CI: 1.02, 5.6). Physiological BPD was 46% in the NCPAP group compared with 11% in the NIPPV group (OR: 6.6, 95% CI: 2.4, 17.8; P ¼ 0.001). There were no differences in any other outcomes between the two groups. Keywords: respiratory distress syndrome; surfactant; preterm; bronchopulmonary dysplasia; NIPPV; NCPAP Introduction Respiratory distress syndrome (RDS) is the most common respiratory morbidity in preterm infants. Surfactant therapy and mechanical ventilation have become the standard of care in preterm infants with RDS. Bronchopulmonary dysplasia (BPD) continues to remain a major morbidity among preterm very low birth weight infants despite the increasing use of antenatal steroids, surfactant therapy and significant advances in mechanical ventilation. 1-3 BPD is associated with both short-and long-term morbidities in very low birth weight infants. Factors associated with BPD include prolonged intubation, mechanical ventilation, barotrauma, volutrauma or oxygen-induced lung inflammation. 4 Early surfactant administration followed by extubation to nasal continuous positive airway pressure (NCPAP) or NCPAP alone without surfactant therapy have been shown to decrease the incidence of BPD in very low birth weight infants in observational studies. 5,6 Findings of a multicenter randomized controlled trial 7 investigating whether early versus late treatment with surfactant reduced the requirement of mechanical ventilation in very preterm infants primarily supported by NCPAP found that early surfactant treatment improved oxygenation 6 h after randomization and reduced the need for mechanical ventilation via endotracheal tube (MVET) before discharge from 68 to 25%. In addition, early surfactant administration followed by extubation to NCPAP in infants <30 weeks gestational age significantly decreased the need for MVET to 0% by 7 day...

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Section: Discussionmentioning

confidence: 99%

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

et al. 2012

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“…13 Clinical retrospective data from the NICHD/NRN benchmarking trial was used to evaluate the use of SNIPPV in infants p1250 g birth weight. 27 The use of SNIPPV in three birth weight sub-groups (500-750, 751-1000, 1001-1250 g, decided a priori) was . 27 Selected studies of SNIPPV and NIPPV use in neonates have been summarized in Tables 1 and 2, respectively.…”

Section: (S)nippv Complicationsmentioning

confidence: 99%

“…27 The use of SNIPPV in three birth weight sub-groups (500-750, 751-1000, 1001-1250 g, decided a priori) was . 27 Selected studies of SNIPPV and NIPPV use in neonates have been summarized in Tables 1 and 2, respectively.…”

Section: (S)nippv Complicationsmentioning

confidence: 99%

Nasal intermittent positive pressure ventilation in the newborn: review of literature and evidence-based guidelines

Bhandari

2009

J Perinatol

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“…Nonsynchronized nasal ventilation may be better than even short periods of invasive SIMV, in terms of decreasing ventilator-associated lung injury. Recently, in a large retrospective study, 38 SNIPPV when compared to NCPAP in preterm neonates with birth weight of 500 to 750 g, is associated with significantly less BPD, BPD/death, neurodevelopmental impairment or neurodevelopmental impairment/death.…”

Section: Ncpap Versus Nippvmentioning

confidence: 99%

Nasal respiratory support through the nares: its time has come

Ramanathan

2010

J Perinatol

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Respiratory distress syndrome (RDS) is the most common respiratory morbidity in preterm infants. Surfactant therapy and invasive mechanical ventilation through the endotracheal tube (ETT) have been the cornerstones in RDS management. Despite improvements in the provision of mechanical ventilation, bronchopulmonary dysplasia (BPD), a multifactorial disease in which invasive mechanical ventilation is a known contributory factor, remains an important cause of morbidity among preterm infants. Barotrauma, volutrauma or oxygen-induced lung inflammation (oxy-trauma) contributes significantly to the development of BPD in neonates ventilated through an ETT. Recently, nasal respiratory support has been increasingly used in preterm infants in an attempt to decrease post-extubation failure and, perhaps, BPD, and for the treatment of apnea of prematurity in nonventilated neonates. Observational studies using noninvasive respiratory support, such as nasal continuous positive airway pressure (NCPAP), have shown a decrease in the incidence of BPD when used to avoid intubation or minimize the duration of invasive mechanical ventilation through the ETT. Moreover, synchronized as well as nonsynchronized nasal intermittent positive-pressure ventilation (NIPPV) have been shown to significantly decrease post-extubation failure compared with NCPAP and their use has been associated with a reduced risk of BPD in small randomized controlled clinical trials. More recently, early surfactant administration followed by extubation to NIPPV has been suggested to be synergistic in decreasing BPD. Although these findings are promising, additional studies evaluating different nasal interfaces, flow synchronization, synchronization using neurally adjusted ventilatory assist mode, and closed loop control of oxygen during nasal ventilation to minimize lung injury are needed in an attempt to further decrease the incidence of lung injury in preterm neonates requiring respiratory support.

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Synchronized Nasal Intermittent Positive-Pressure Ventilation and Neonatal Outcomes

Cited by 88 publications

References 49 publications

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

Nasal intermittent positive pressure ventilation in the newborn: review of literature and evidence-based guidelines

Nasal respiratory support through the nares: its time has come

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