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

Gizzi, Camilla; Montecchia, F.; Panetta, Valentina; Castellano, Chiara; Mariani, Chiara; Campelli, Maristella; Papoff, Paola; Moretti, Corrado; Agostino, Rocco

doi:10.1136/archdischild-2013-305892

Cited by 95 publications

(69 citation statements)

References 37 publications

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“…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.…”

Section: Discussionsupporting

confidence: 77%

“…As it is unclear whether SNIPPV would be even more effective in treating apnea, we conducted a clinical trial to assess the effects of NCPAP, NIPPV and flow-SNIPPV on rates of desaturations and bradycardias in VLBW infants and to evaluate the influence of these modes of ventilation on pattern of breathing and gas exchange [31]. Nineteen infants with a mean gestation at study of 30 weeks suffering from apneic spells were enrolled in a randomized controlled trial with a cross-over design.…”

Section: Clinical Results With Snippvmentioning

confidence: 99%

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

et al. 2016

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Although mechanical ventilation via an endotracheal tube has undoubtedly led to improvement in neonatal survival in the last 40 years, the prolonged use of this technique may predispose the infant to development of many possible complications including bronchopulmonary dysplasia. Avoiding mechanical ventilation is thought to be a critical goal, and different modes of noninvasive respiratory support beyond nasal continuous positive airway pressure, such as nasal intermittent positive pressure ventilation and synchronized nasal intermittent positive pressure ventilation, are also available and may reduce intubation rate. Several trials have demonstrated that the newer modes of noninvasive ventilation are more effective than nasal continuous positive airway pressure in reducing extubation failure and may also be more helpful as modes of primary support to treat respiratory distress syndrome after surfactant and for treatment of apnea of prematurity. With synchronized noninvasive ventilation, these benefits are more consistent, and different modes of synchronization have been reported. Although flow-triggering is the most common mode of synchronization, this technique is not reliable for noninvasive ventilation in neonates because it is affected by variable leaks at the mouth and nose. This review discusses the mechanisms of action, benefits and limitations of noninvasive ventilation, describes the different modes of synchronization and analyzes the technical characteristics, properties and clinical results of a flow-sensor expressly developed for synchronized noninvasive ventilation.

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Section: Discussionsupporting

confidence: 77%

Section: Clinical Results With Snippvmentioning

confidence: 99%

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

et al. 2016

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“…Recently, a group in Italy published a randomised, crossover study of synchronised non-invasive positive pressure ventilation (S-NIPPV) compared with standard NIPPV or CPAP in 19 preterm infants that found S-NIPPV to be more effective in reducing central apnoea 35. This new respiratory modality should be studied in a larger cohort to see whether the benefit is reproducible.…”

Section: Treatmentmentioning

confidence: 99%

Treatment options for apnoea of prematurity

Morton

Smith

2016

Arch Dis Child Fetal Neonatal Ed

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Apnoea of prematurity (AOP) affects almost all infants born at <28 weeks gestation or with birth weight <1000 g. When untreated, AOP may be associated with negative outcomes. Because of these negative outcomes, effective treatment for AOP is an important part of optimising care of preterm infants. Standard treatment usually involves xanthine therapy and respiratory support. Cutting-edge work with stochastic vibrotactile stimulation and new pharmaceutical agents continues to expand therapeutic options. In this article, we review the pathophysiology of AOP, associated conditions and treatment options.

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“…Gizzi et al [17] recently reported that flow-synchronized nasal intermittent positive pressure ventilation (i.e. S-NIMV), compared to NIMV or CPAP, is associated with less desaturation and/or bradycardia and central apnea in preterm infants.…”

Section: Discussionmentioning

confidence: 99%

“…Our study demonstrated that during S-NIMV, 10 infants had no severe bradycardia events but that during NIMV, only 5 infants had no such events. Flow synchronization for NIMV is only available with the specific ventilator used by Gizzi et al [17] , which seems to be able to synchronize despite large leaks which usually occur with noninvasive ventilation in neonates. Other studies demonstrated that asynchronous ventilator inflations might increase the risk of adverse effects like pneumothorax [13] , BP and cerebral blood flow velocity fluctuations [8,18] as well as WOB in immature infants [8,10] .…”

Section: Discussionmentioning

confidence: 99%

Effects of Synchronization during Noninvasive Intermittent Mandatory Ventilation in Preterm Infants with Respiratory Distress Syndrome Immediately after Extubation

Huang¹,

Mendler²,

Waitz³

et al. 2015

Neonatology

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Background: Noninvasive ventilation is increasingly used in very-low-birth-weight infants (VLBWI) to reduce complications that occur with invasive ventilation. However, the physiological effects of synchronization during noninvasive nasal intermittent mandatory ventilation (IMV) have not been tested in VLBWI immediately after extubation. Objective: We aimed to study the short-term effects of synchronized nasal IMV (S-NIMV) compared to nonsynchronized nasal IMV (NIMV) on breathing effort as measured by phasic esophageal pressure (Pe) deflection, spontaneous respiratory rate (RR), gas exchange, cerebral tissue oxygen saturation (StO₂) and intermittent episodes of bradycardia or hypoxemia in VLBWI recovering from respiratory distress syndrome (RDS). Methods: Fourteen VLBWI recovering from RDS were studied using a randomized cross-over design during both S-NIMV and NIMV (of 2 h each) immediately after extubation. Results: Phasic Pe deflection, spontaneous RR and transcutaneous PCO₂ decreased significantly while transcutaneous PO₂ and synchrony rate (defined as peak ventilator pressure delivered within the first half of spontaneous inspiration) increased significantly during S-NIMV compared to during NIMV. There was no difference in blood pressure, average arterial oxygen saturation (SpO₂), cerebral StO₂, fractional tissue oxygen extraction of the brain and severe bradycardia (defined as time with a heart rate <100 beats/min lasting ≥10 s) and in hypoxemic episodes (SpO₂ <80%) between the two modes. Conclusion: Synchronization during nasal ventilation immediately after extubation in VLBWI recovering from RDS improved gas exchange and decreased the respiratory effort, and it could therefore be considered to provide a more efficient respiratory support and synchrony.

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

Cited by 95 publications

References 37 publications

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

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

Treatment options for apnoea of prematurity

Effects of Synchronization during Noninvasive Intermittent Mandatory Ventilation in Preterm Infants with Respiratory Distress Syndrome Immediately after Extubation

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