A randomized trial comparing the short binasal prong to the RAM cannula for noninvasive ventilation support of preterm infants with respiratory distress syndrome

Gökçe, İsmail Kürşad; Kaya, Hüseyin; Оздемир, Рамазан

doi:10.1080/14767058.2019.1651268

Cited by 17 publications

(28 citation statements)

References 19 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: 87%

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: 87%

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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“…However, this study was done in a before-and-after study design, with small sample size. In an RCT, Gokce et al compared RAM cannula (n = 64) with Hudson prongs (n = 62) in preterm neonates (26–34 weeks’ gestation) for non-invasive respiratory support 11 . Incidence of nasal injury (defined as stage I—hyperemia and hemorrhage, stage II—disruption of skin integrity and superficial ulceration, stage III—nasal deformity) was similar between the two groups (8 vs. 7; p = 0.83).…”

Section: Discussionmentioning

confidence: 99%

“…The RAM cannula (Neotech, Valencia, CA) was approved by the Food and Drug Administration as a Class I medical device for providing supplemental oxygen with 60–80% nasal occlusion 7 . It was being used off-label to provide nCPAP because of its ease of use and perception of decreased nasal injury 8 – 11 . The device looks similar to a traditional nasal cannula used to deliver oxygen, but its stiffer design allows a higher flow rate and pressure delivery.…”

Section: Introductionmentioning

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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“…[11][12][13][14][15][16] In addition, in a recent clinical trial on preterm infants affected by respiratory distress syndrome (RDS), RAM cannula used for NIPPV in comparison with SBP resulted in an increased need for MV and surfactant use. 17 These data show that a circuit assembled with DILC and employed for NCPAP or NIPPV has fluidic and operating features that are different from standard circuits with SBP.…”

mentioning

confidence: 94%

“…The low efficacy of a popular model of DILC was demonstrated by multiple studies where this device failed to deliver set NCPAP and nasal intermittent mandatory ventilation (NIMV) pressures, probably due to its high resistance 11–16 . In addition, in a recent clinical trial on preterm infants affected by respiratory distress syndrome (RDS), RAM cannula used for NIPPV in comparison with SBP resulted in an increased need for MV and surfactant use 17 . These data show that a circuit assembled with DILC and employed for NCPAP or NIPPV has fluidic and operating features that are different from standard circuits with SBP.…”

Section: Introductionmentioning

confidence: 99%

Flow‐synchronized NIPPV with double‐inspiratory loop cannula: An in vitro study

Moretti

Lista

Carnielli

et al. 2020

Pediatric Pulmonology

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Background: Although short binasal prongs (SBP) are the most common interface for noninvasive ventilation, the "double-inspiratory loop cannulas" (DILC) have recently been introduced into many neonatal intensive care units. DILC show advantages over SBP, including reduced nasal trauma and increased comfort. However, their higher intrinsic resistance may compromise ventilation. Our aim was to test a new, low resistance DILC interface. Methods: A test lung was programmed to simulate preterm neonates (500-2000 g BW) with moderate-to-severe respiratory distress syndrome. The artificial nose was designed to keep prongs-to-nares leaks to around 30%. Giulia ® ventilator (GINEVRI srl) was used to provide nasal continuous positive airway pressure (NCPAP) and flow synchronized nasal intermittent positive pressure ventilation (NIPPV). NCPAP was set at 4-10 cmH 2 O and synchronized-NIPPV (SNIPPV) at peak inspiratory pressure, 15-20-25 cmH 2 O; inspiratory time, 0.3-0.5 s; and positive end-expiratory pressure, 5-8 cmH 2 O. Four sizes of Sync-flow Cannula ® (GINEVRI srl) were tested. The Sync-flow Cannula ® was compared with Neotech RAM ® cannula and Ginevri SBP ®. The outcome measures were the flow/pressure relationship through the four Sync-flow Cannula ® sizes, the difference in resistance, the drop in ventilator-alveoli pressure measured by the test lung and the system response time during flow-SNIPPV. Results: The smaller DILC sizes had the lowest flow-pressure ratio. The resistance of the RAM ® cannula was significantly higher compared to the other interfaces (p < .001). With 30% leaks, there was a 4-38% ventilator-alveoli drop in pressure, depending on interface size. The system response time was excellent (~65-70 ms). Conclusions: With about 30% leaks, the Sync-flow Cannula ® interfaces result in good pressure transmission and give optimal performance for flow-SNIPPV. Clinical studies are needed to confirm the clinical relevance of these data.

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A randomized trial comparing the short binasal prong to the RAM cannula for noninvasive ventilation support of preterm infants with respiratory distress syndrome

Cited by 17 publications

References 19 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

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

Flow‐synchronized NIPPV with double‐inspiratory loop cannula: An in vitro study

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