Hemodynamic Effects of Nasal Intermittent Positive Pressure Ventilation in Preterm Infants

Abstract

Nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) have proven to be effective modes of noninvasive respiratory support in preterm infants. Although they are increasingly used in neonatal intensive care, their hemodynamic consequences have not been fully evaluated. The aim of this study was to investigate the hemodynamic changes between NIPPV and NCPAP in preterm infants.This prospective observational study enrolled clinically stable preterm infants requiring respiratory support received NCPAP and nonsynchronized NIPPV at 40/minute for 30 minutes each, in random order. Cardiac function and cerebral hemodynamics were assessed by ultrasonography after each study period. The patients continued the study ventilation during measurements.Twenty infants with a mean gestational age of 27 weeks (range, 25–32 weeks) and birth weight of 974 g were examined at a median postnatal age of 20 days (range, 9–28 days). There were no significant differences between the NCPAP and NIPPV groups in right (302 vs 292 mL/kg/min, respectively) and left ventricular output (310 vs 319 mL/kg/min, respectively), superior vena cava flow (103 vs 111 mL/kg/min, respectively), or anterior cerebral artery flow velocity.NIPPV did not have a significant effect on the hemodynamics of stable preterm infants. Future studies assessing the effect of NIPPV on circulation should focus on less stable and very preterm infants.

Heart Rate Variability in Extremely Preterm Infants Receiving Nasal CPAP and Non-Synchronized Noninvasive Ventilation Immediately After Extubation

“…26 Finally, another study in stable preterm infants revealed no significant differences in cardiac function and cerebral hemodynamics between nasal CPAP and ns-NIV. 27 Our study is the first to investigate the effects of ns-NIV and nasal CPAP on HRV during the immediate postextubation phase. Although an increased level of support resulting from ns-NIV would have theoretically influenced HRV parameters, no statistically significant changes were observed.…”

Effect of ventilator modes on neonatal cerebral and peripheral oxygenation using near‐infrared spectroscopy

“…However, the authors themselves note a marked trend towards lower blood flow in infants on HFO even though it did not reach statistical significance. Non‐invasive modes of positive pressure administration have also been studied but seem to have less of an effect on cardiac output 8,9 …”

Effect of non–invasive ventilation on central and brain hemodynamics in term newborn infants with hypoxic – ischemic encephalopathy

“…Chang HY et al (2016) also studied the hemodynamic effects of NIPPV in a prospective study of clinically stable but preterm infants, and believe that noninvasive AV does not affect systemic hemodynamics and cerebral blood flow, but note that for a more detailed study of hemodynamic effects of this type of AV larger studies using NIPPV over a longer period of time are needed [19].…”