Flow-Synchronized Nasal Intermittent Positive Pressure Ventilation for Infants <32 Weeks' Gestation with Respiratory Distress Syndrome

Abstract

Aim. To evaluate whether synchronized-NIPPV (SNIPPV) used after the INSURE procedure can reduce mechanical ventilation (MV) need in preterm infants with RDS more effectively than NCPAP and to compare the clinical course and the incidence of short-term outcomes of infants managed with SNIPPV or NCPAP. Methods. Chart data of inborn infants <32 weeks undergoing INSURE approach in the period January 2009–December 2010 were reviewed. After INSURE, newborns born January –December 2009 received NCPAP, whereas those born January–December 2010 received SNIPPV. INSURE failure was defined as FiO2 need >0.4, respiratory acidosis, or intractable apnoea that occurred within 72 hours of surfactant administration. Results. Eleven out of 31 (35.5%) infants in the NCPAP group and 2 out of 33 (6.1%) infants in the SNIPPV group failed the INSURE approach and underwent MV (P < 0.004). Fewer infants in the INSURE/SNIPPV group needed a second dose of surfactant, a high caffeine maintenance dose, and pharmacological treatment for PDA. Differences in O2 dependency at 28 days and 36 weeks of postmenstrual age were at the limit of significance in favor of SNIPPV treated infants. Conclusions. SNIPPV use after INSURE technique in our NICU reduced MV need and favorably affected short-term morbidities of our premature infants.

Synchronized Nasal Intermittent Positive Pressure Ventilation of the Newborn: Technical Issues and Clinical Results

“…Our clinical observations [14,29,31] are consistent with laboratory data [16] and show that the Giulia® flow-trigger is reliable to provide SNIPPV for treatment of neonatal respiratory failure. From clinical trials, SNIPPV seems more effective than NIPPV and NCPAP in reducing need for intubation in RDS, in improving the success of extubation and in treating apnea of prematurity, with a reassuring absence of relevant side effects.…”

“…In 2007, a trial by Bhandari et al [28] confirmed the beneficial effects of SNIPPV for VLBW infants with RDS and the lower incidence of BPD among those treated with this technique compared to MV. We conducted a study using flow-SNIPPV as the primary mode of ventilatory support in infants <32 weeks' gestation with RDS [29]. The aim of the trial was to evaluate whether flow-SNIPPV, used immediately after the INSURE technique, was effective in further reducing the incidence of MV when compared to the conventional INSURE/NCPAP treatment.…”

Is synchronised NIPPV more effective than NIPPV and NCPAP in treating apnoea of prematurity (AOP)? A randomised cross-over trial

“…Until present, two devices have been commonly used to trigger the ventilator during NIV in preterm infants: the abdominal capsule,29–32 and the flow sensor 17 33 34. Recently, a device using a diaphragmatic electromyogram has been introduced, however little data are available on clinical outcomes35 The abdominal capsule, although quite effective, has some disadvantages relating to the high sensitivity to the infant's spontaneous movements and to the considerable skill required for correct placement.…”

Neonatal Non-Invasive Respiratory Support: Synchronised NIPPV, Non-Synchronised NIPPV or Bi-Level CPAP: What Is the Evidence in 2013?

“…While there are some encouraging non-randomised data [54], RCTs comparing NIPPV or BiPAP with NCPAP have failed to show a convincing effect on BPD. Although nine RCTs have included BPD as a secondary outcome, none of these trials were powered to detect differences in BPD rates.…”