1799 Respiratory Signals from the External Body Surface in Spontaneously Breathing Preterm Infants

Flemmer, A.; Owen, Louise; Schulze, Andreas; Herber-Jonat, Susanne; Davis, PG

doi:10.1136/archdischild-2012-302724.1799

Cited by 3 publications

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“…These and previous studies5 6 12 13 report adequate synchrony can be achieved during NIPPV by means of the Graseby pressure capsule placed on the abdomen or an inline flow sensor. This is important because these techniques were used in 4 of the trials that showed higher extubation success with synchronised NIPPV compared with NCPAP 14–17…”

supporting

confidence: 62%

Non-invasive ventilation in premature infants

Claure

Bancalari

2014

Arch Dis Child Fetal Neonatal Ed

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Non-invasive respiratory support in preterm infants traditionally consisted of the application of continuous distending positive pressure at the nose. More recently, the continuous distending pressure has been combined with intermittent positive pressure cycles using conventional ventilators or devices developed specifically for this purpose. One of the common terms used to refer to these modalities is nasal intermittent positive pressure ventilation (NIPPV). These modalities or devices vary depending on the peak pressure of each cycle, how fast it rises, the duration of the cycle and cycling frequency and whether the positive pressure cycle can be synchronised to the spontaneous inspiration. The mechanisms of action, benefits and limitations of the different devices, modalities and/or applied settings have not been fully explored. Three separate studies sought to improve the understanding of some of these modalities of respiratory support. 1-3Bi-level positive airway pressure (BiPAP) has been proposed as a way to provide higher mean airway pressure (MAP) without the possible side effects of a continuously high distending pressure while the infant is able to breathe at both pressure levels. Lampland et al tested the hypothesis that applying BiPAP without increasing MAP would improve gas exchange compared with nasal continuous positive airway pressure (NCPAP). Twenty preterm infants of median gestational age (GA) of 26 weeks and 33 days old were crossed over twice between NCPAP and BiPAP for 1 h each. During BiPAP, positive end-expiratory pressure (PEEP) and peak pressure were adjusted to provide a minimum Δ pressure of 3 cm H 2 O for 1 s at a rate of 20/min and match the MAP to the NCPAP level of 6 cm H 2 O. These investigators found arterial oxygen saturation (SpO 2 ), fraction of inspired oxygen (FiO 2 ), transcutaneous CO 2 tension (TcPCO 2 ), respiratory rate (RR) and frequency of apnoea, bradycardia or hypoxaemia spells did not differ between NCPAP and BiPAP. These findings differ from those obtained in a similar study where BiPAP provided higher MAP than NCPAP. 4 This difference in results suggests the gains achieved by the relatively small Δ pressure cycles might have been counteracted by the lower PEEP during BiPAP. It is unknown if cycles with a larger Δ pressure or a longer duration would have achieved different effects. The lack of effect may also be because these infants were already stable on NCPAP and thus did not need the additional support.Another proposed benefit of BiPAP is that the positive pressure cycle would improve tidal volume (VT) or facilitate its generation by assisting every spontaneous inspiration. This requires synchronising the BiPAP cycle to the onset of the spontaneous inspiration. Owen et al assessed the synchronisation achieved by a BiPAP device using the Graseby pressure capsule applied on the infant's abdomen and its effects on VT and the backup ventilation provided during apnoea. Ten premature infants of 26 weeks GA were studied at a mean age of 29 days. Thirty-minute record...

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supporting

confidence: 62%

Non-invasive ventilation in premature infants

Claure

Bancalari

2014

Arch Dis Child Fetal Neonatal Ed

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“…Other methods of achieving non-invasive synchronisation for NIPPV, such as via RIP, may be effective and are being investigated 31. Following the withdrawal of the original ventilators that used GC synchronisation technology, and in light of the continued growth of non-invasive support, current ventilator manufacturers have begun to reincorporate GC technology into their systems, for example, Stephanie and Sophie ventilators (Stephan Medizintechnik, Gackenbach, Germany).…”

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confidence: 99%

Effects of synchronisation during SiPAP-generated nasal intermittent positive pressure ventilation (NIPPV) in preterm infants

Owen

Morley

Davis

2014

Arch Dis Child Fetal Neonatal Ed

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Objective The SiPAP flow driver (Care Fusion, Dublin, Ohio, USA) offers synchronised nasal intermittent positive pressure ventilation (sNIPPV) using an abdominal capsule. This study aims to describe the accuracy and effects of synchronised NIPPV using SiPAP in preterm infants. Design Ten infants, born <28 weeks' gestation, receiving synchronised SiPAP-generated NIPPV, in 'biphasic trigger' mode, were observed. Abdominal capsule signals, delivered pressures, respiratory pattern and oxygen saturations were recorded. Tidal volume (V T ), apnoeas, proportion of breaths supported by SiPAP and time between inspiration onset and SiPAP pressure rise were analysed. Results Infants were of median 26 +0 weeks' gestational age and birth weight 776 g. Mean (SD) respiratory rate (RR) was 53 (14)/min. 82% (17) of spontaneous breaths triggered a SiPAP pressure peak. Mean time between inspiration and SiPAP pressure rise was 28 (20) ms. There was no difference in V T when breaths triggered a SiPAP pressure peak compared with breaths without a pressure peak. No V T was generated by pressure peaks delivered during apnoea. Capsule signals were not recognised following >10% of breaths, resulting in asynchronous NIPPV delivery. Movements resulted in irregular SiPAP pressures and desaturation. When the RR was faster, >55/min, breaths irregularly triggered a SiPAP pressure peak ( p=0.003). Compared with times when every breath resulted in a pressure peak, lower mean pressures were achieved, 7.9 vs 8.4 cm H 2 O ( p=0.02). Conclusions The SiPAP synchronisation system triggered rapidly with most spontaneous breaths, but did not result in larger tidal volumes. When the RR was >55/min, the SiPAP delivered fewer pressure peaks at lower pressures. BACKGROUND

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„Nasal continuous positive airway pressure“ und noninvasive Beatmung bei Frühgeborenen

Wald

2014

Monatsschr Kinderheilkd

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1799 Respiratory Signals from the External Body Surface in Spontaneously Breathing Preterm Infants

Cited by 3 publications

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Non-invasive ventilation in premature infants

Non-invasive ventilation in premature infants

Effects of synchronisation during SiPAP-generated nasal intermittent positive pressure ventilation (NIPPV) in preterm infants

„Nasal continuous positive airway pressure“ und noninvasive Beatmung bei Frühgeborenen

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