Tidal volume transmission during non-synchronized nasal intermittent positive pressure ventilation via RAM® cannula

Matlock, David N.; Bai, Shasha; Weisner, Michael D.; Comtois, Norman; Beck, Jennifer; Sinderby, Christer A.; Courtney, Sherry E.

doi:10.1038/s41372-019-0333-x

Cited by 25 publications

(16 citation statements)

References 12 publications

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“…5,7,14,18,19 Infants randomized to the RAM cannula versus SBP with NIPPV had increased need for mechanical ventilation at birth, and NIPPV-neurally adjusted ventilatory assist breaths through the RAM cannula had little effect on tidal volumes. 22,23 Our bench study demonstrates increasing transmission of pressures with larger RAM cannula sizes (newborn and infant) and clinicians should take into account the nasal occlusion percentage and the size of the cannula when determining pressures at the bCPAP bottle.…”

Section: Discussionmentioning

confidence: 91%

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

et al. 2020

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Objective Early bubble continuous positive airway pressure (bCPAP) in the delivery room (DR) reduces early intubation, mechanical ventilation, and bronchopulmonary dysplasia. The RAM cannula, adopted for ease of patient care, is a high resistance nasal interface that, when used with bCPAP, only transmits a portion of set pressures and attenuates the bubble effects. This study aimed to review early bCPAP pressures and bCPAP failure with the RAM cannula interface over a 6-year period. Study Design Retrospective, single-center study of infants delivered <1,250 g from 2013 to 2018 (n = 735) begun on bCPAP in the DR with the RAM cannula. In vitro testing of bCPAP pressure transmission was also performed for multiple nasal interfaces and nasal occlusion percentages. Results The percentage of infants intubated in the DR decreased over time (59 to 42%), while the average bCPAP pressure increased from 5.3 to 6.8 cmH2O. A total of 355 infants (48%) were admitted to the neonatal intensive care unit (NICU) from the DR on BCPAP. The failure rate for bCPAP in NICU within 72 hours decreased from 45 to 24% as the maximum CPAP increased from 5.8 to 7.6 cmH2O. Pneumothorax rates did not change. CPAP pressure transmission decreased with all sizes of the RAM cannula. Conclusion When utilizing the RAM cannula for bCPAP, higher CPAP levels were associated with decreases in DR intubations and CPAP failure within the first 72 hours. If clinicians choose to use the RAM cannula for bCPAP, they will need higher set pressures to achieve lung inflation and the beneficial oscillatory effect will be diminished. Key Points

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Section: Discussionmentioning

confidence: 91%

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

et al. 2020

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“…Matlock et al showed a smaller tidal volume was delivered via RAM cannula than that produced by spontaneous breathing while using NIPPV. 21…”

Section: Discussionmentioning

confidence: 99%

Noninvasive High-Frequency Oscillatory Ventilation: A Retrospective Chart Review

et al. 2020

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Objective This study aimed to review the feasibility of nasal high-frequency oscillatory ventilation (NHFOV) in preventing reintubation in preterm infants Study Design This is a retrospective cohort study of all premature newborn infants placed on NHFOV in a single-center neonatal intensive care unit. Results Twenty-seven patients (birth weight: 765 ± 186 g, gestational age: 28 ± 2 weeks) were commenced on NHFOV on 32 occasions. NHFOV was used immediately postextubation as the primary mode of noninvasive ventilation (NIV; prophylaxis) in 10 of 32 occasions and as “rescue” (failure of NCPAP or biphasic CPAP) in 22 of 32 occasions. Treatment with NHFOV was successful in 22 occasions (69%) while on 10 occasions (31%) reintubation was required within 72 hours. In the rescue group, there was significant reduction in the mean (standard deviation [SD]) number of apneas (0.9 ± 1.07 vs. 0.3 ± 0.29, p < 0.005), but there were no significant changes in the PCO2 level (52 [ ± 9.8] vs. 52 [ ± 8.6] mm Hg, p = 0.8), or the FiO2 requirement (0.39 ± 0.19 vs. 0.33 ± 0.10, p = 0.055) before and after commencing NHFOV, respectively. Conclusion The use of NHFOV is feasible as a prophylactic or rescue mode of NIV following extubation and was associated with decrease in the number of apneas without significant changes in PCO2 or oxygen requirements. A well-designed randomized control trial is needed to determine the indications, clinical outcomes, and safety of this treatment modality. Key Points

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“…Physiological studies showed that RAM cannula had high resistance 15 , pressure delivered was acceptable with leaks < 30% 16 , and it could not deliver set CPAP levels when applied using the manufacturer’s recommended 60–80% nares occlusion, even with closed mouth and full nasal prong insertion 14 . Matlock et al noted that NIPPV with RAM cannula produced clinically insignificant tidal volumes in preterm neonates between 24 and 34 weeks during non-spontaneous inflations 20 . Sharma et al compared the pressures delivered by three different nasal interfaces (nasal mask, Hudson prong, RAM cannula) on 30 neonates in each group with gestation 28–34 weeks and birth weight ≥ 1000 g in our centre, during this study period 21 .…”

Section: Discussionmentioning

confidence: 99%

RAM cannula with Cannulaide versus Hudson prongs for delivery of nasal continuous positive airway pressure in preterm infants: an RCT

Maram

Murki

Nayyar

et al. 2021

Sci Rep

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Nasal continuous positive airway pressure (nCPAP) is the standard non-invasive respiratory support for newborns with respiratory distress. Nasal injury is a common problem with the interfaces used. To compare the incidence and severity of nasal injury in neonates with respiratory distress and supported on nCPAP with Hudson prong or RAM cannula with Cannulaide, a semipermeable membrane. This is an open-label, parallel-arm, gestational age-stratified, bi-centric, randomized control trial including neonates between 28 and 34 weeks gestational age and birth weight > 1000 g needing nCPAP. The size of the interface was chosen as per the manufacturer’s recommendation. Of the 229 neonates enrolled, 112 were randomized to RAM cannula with Cannulaide and 117 to Hudson prong. The baseline characteristics were similar. Any nasal injury at CPAP removal was significantly lower in the RAM cannula with Cannulaide group [6 (5.4%) vs. 31 (26.4%); risk ratio—0.77 (95% CI 0.69–0.87); p = 0.0001]. The incidence of moderate to severe nasal injury, need for mechanical ventilation within 72 h of age, duration of oxygen, and requirement of nCPAP for > 3 days were similar. For preterm infants on nCPAP, RAM cannula with Cannulaide, compared to Hudson prongs, decreases nasal injury without increasing the need for mechanical ventilation.Trail registration: CTRI/2019/03/018333, http://www.ctri.nic.in.

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Tidal volume transmission during non-synchronized nasal intermittent positive pressure ventilation via RAM® cannula

Cited by 25 publications

References 12 publications

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

Noninvasive High-Frequency Oscillatory Ventilation: A Retrospective Chart Review

RAM cannula with Cannulaide versus Hudson prongs for delivery of nasal continuous positive airway pressure in preterm infants: an RCT

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