Use of Nasal Non-Invasive Ventilation with a RAM Cannula in the Outpatient Home Setting

Rojas, Wilfredo De Jesús; Samuels, Cheryl; Gonzales, Traci; McBeth, K.; Yadav, Aravind; Stark, James M.; Jon, Cindy; Mosquera, Ricardo A.

doi:10.2174/1874306401711010041

Cited by 12 publications

(14 citation statements)

References 8 publications

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“…There are many factors that affect the mean airway pressure delivered to an infant on nasal CPAP. These include the seal of the nasal interface, loss of pressure through the mouth, the resistance of the airways, as well as the resistance of the device 1 13 14. This study assessed the pressure differential created by the intrinsic resistance of commonly used nasal CPAP interfaces; this is of potential clinical importance as lower resistance interfaces will result in less pressure loss during delivery of gas to the infant’s upper airway.…”

Section: Discussionmentioning

confidence: 99%

Assessment of resistance of nasal continuous positive airway pressure interfaces

Green

Dawson²,

Davis

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo compare the resistance of interfaces used for the delivery of nasal continuous positive airway pressure (CPAP) in neonates, as measured by the generated system pressure at fixed gas flows, in an in vitro setting.DesignGas flows of 6, 8 and 10 L/min were passed through three sizes of each of a selection of available neonatal nasal CPAP interfaces (Hudson prong, RAM Cannula, Fisher & Paykel prong, Infant Flow prong, Fisher & Paykel mask, Infant Flow mask). The expiratory limb was occluded and pressure differential measured using a calibrated pressure transducer.ResultsVariation in resistance, assessed by mean pressure differential, was seen between CPAP interfaces. Binasal prong interfaces typically had greater resistance at the smallest assessed sizes, and with higher gas flows. However, Infant Flow prongs produced low pressures (<1.5 cmH2O) at all sizes and gas flows. RAM Cannula had a high resistance, producing a pressure >4.5 cmH2O at all sizes and gas flows. Both nasal mask interfaces had low resistance at all assessed sizes and gas flows, with recorded pressure <1 cmH2O in all cases.ConclusionsThere is considerable variation in measured resistance of available CPAP interfaces at gas flows commonly applied in clinical neonatal care. Use of interfaces with high resistance may result in a greater drop in delivered airway pressure in comparison to set circuit pressure, which may have implications for clinical efficacy. Device manufacturers and clinicians should consider CPAP interface resistance prior to introduction into routine clinical care.

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Section: Discussionmentioning

confidence: 99%

Assessment of resistance of nasal continuous positive airway pressure interfaces

Green

Dawson²,

Davis

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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show abstract

“…It may be difficult to find a well-fitted interface for children with facial deformity [141,154]. Case series studies reported a successful use of a humidified high-flow nasal cannula (HFNC) with a regular CPAP device [158] or of the nasal RAM cannula [159] with a NIV device for children who did not tolerate a commercial interface. Recently, a nasal cloth mask has become available for children > 2 years of age who have plastic intolerance [160].…”

Section: And 42)mentioning

confidence: 99%

ERS statement on paediatric long-term noninvasive respiratory support

et al. 2021

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Long term noninvasive respiratory support, comprising continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), in children is expanding worldwide, with increasing complexities of children being considered for this type of ventilator support and expanding indications such as palliative care. There have been improvements in equipment and interfaces. Despite growing experience, there are still gaps in a significant number of areas: there is a lack of validated criteria for CPAP/NIV initiation, optimal follow-up and monitoring; weaning and long term benefits have not been evaluated. Therapeutic education of the caregivers and the patient is of paramount importance, as well as continuous support and assistance, in order to achieve optimal adherence. The preservation or improvement of the quality of life of the patient and caregivers should be a concern for all children treated with long term CPAP/NIV. As NIV is a highly specialised treatment, patients are usually managed by an experienced pediatric multidisciplinary team. This Statement written by experts in the field of pediatric long term CPAP/NIV aims to emphasize on the most recent scientific input and should open up to new perspectives and research areas.

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“…4,8,15,16 The Ramanathan (RAM) nasal cannula is an interface used to deliver either CPAP or BiPAP. 2,[17][18][19][20] Use of the RAM cannula originated in the neonatal intensive care unit where it is associated with reduced extubation failure and intubation rates in children with neonatal respiratory distress syndrome. 18,19 This interface has since been applied in the PICU in infants and young children with bronchiolitis or pneumonia with the anecdotal premise that it is better tolerated than mask interfaces.…”

Section: Introductionmentioning

confidence: 99%

Predicting Failure of Non-Invasive Ventilation With RAM Cannula in Bronchiolitis

Maamari

Niño

Bost

et al. 2021

J Intensive Care Med

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Introduction: In infants hospitalized for bronchiolitis on non-invasive ventilation (NIV) via the RAM cannula nasal interface, variables predicting subsequent intubation, or NIV non-response, are understudied. We sought to identify predictors of NIV non-response. Methods: We performed a retrospective cohort study in infants admitted for respiratory failure from bronchiolitis placed on NIV in a quaternary children’s hospital. We excluded children with concurrent sepsis, critical congenital heart disease, or with preexisting tracheostomy. The primary outcome was NIV non-response defined as intubation after a trial of NIV. Secondary outcomes were vital sign values before and after NIV initiation, duration of NIV and intubation, and mortality. Primary analyses included Chi-square, Wilcoxon rank-sum, student’s t test, paired analyses, and adjusted and unadjusted logistic regression assessing heart rate (HR) and respiratory rate (RR) before and after NIV initiation. Results: Of 138 infants studied, 34% were non-responders. There were no differences in baseline characteristics of responders and non-responders. HR decreased after NIV initiation in responders (156 [143-156] to149 [141-158], p < 0.01) compared to non-responders (158 [149-166] to 158 [145-171], p = 0.73). RR decreased in responders (50 [43-58] vs 47 [41-54]) and non-responders (52 [48-58] vs 51 [40-55], both p < 0.01). Concurrent bacterial pneumonia (OR 6.06, 95% CI: 2.54-14.51) and persistently elevated HR (OR: 1.04, 95% CI: 1.01-1.07) were associated with NIV non-response. Conclusion: In children with acute bronchiolitis who fail to respond to NIV and require subsequent intubation, we noted associations with persistently elevated HR after NIV initiation and concurrent bacterial pneumonia.

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Use of Nasal Non-Invasive Ventilation with a RAM Cannula in the Outpatient Home Setting

Cited by 12 publications

References 8 publications

Assessment of resistance of nasal continuous positive airway pressure interfaces

Assessment of resistance of nasal continuous positive airway pressure interfaces

ERS statement on paediatric long-term noninvasive respiratory support

Predicting Failure of Non-Invasive Ventilation With RAM Cannula in Bronchiolitis

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