Non-invasive positive pressure ventilation in the preterm neonate: reducing endotrauma and the incidence of bronchopulmonary dysplasia

Hutchison, Alastair A.; Bignall, S

doi:10.1136/adc.2006.103770

Cited by 39 publications

(26 citation statements)

References 52 publications

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“…It has been suggested that NIPPV pressure changes recruit alveoli and may improve and maintain functional residual capacity [1,19,46], but there are no clinical trials to support this theory.…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…However, it is associated with increased mortality and morbidity, including bronchopulmonary dysplasia (BPD) [1,2]. Despite therapeutic advances such as antenatal steroids, surfactant replacement, high-frequency [3], patient-triggered [4] and volume-targeted ventilation [5], more than 40% of infants born below 28 weeks' gestation still develop BPD [6], and in some centres this figure is rising [7].…”

Section: Introductionmentioning

confidence: 99%

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

2013

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Nasal continuous positive airway pressure (NCPAP) has proven to be an effective mode of non-invasive respiratory support in preterm infants; however, many infants still require endotracheal ventilation, placing them at an increased risk of morbidities such as bronchopulmonary dysplasia. Several other modes of non-invasive respiratory support beyond NCPAP, including synchronised and non-synchronised nasal intermittent positive pressure ventilation (SNIPPV and nsNIPPV) and bi-level positive airway pressure (BiPAP) are now also available. These techniques require different approaches, and the exact mechanisms by which they act remain unclear. SNIPPV has been shown to reduce the rate of reintubation in comparison to NCPAP when used as post-extubation support, but the evidence for nsNIPPV and BiPAP in this context is less convincing. There is some evidence that NIPPV (whether synchronised or non-synchronised) used as primary respiratory support is beneficial, but the variation in study methodology makes this hard to translate confidently into clinical practice. There is currently no evidence to suggest a reduction in mortality or important morbidities such as bronchopulmonary dysplasia, with NIPPV or BiPAP in comparison to NCPAP, and there is a lack of appropriately designed studies in this area. This review discusses the different approaches and proposed mechanisms of action of SNIPPV, nsNIPPV and BiPAP, the challenges of applying the available evidence for these distinct modalities of non-invasive respiratory support to clinical practice, and possible areas of future research.

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Section: Mechanisms Of Actionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2013

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“…Apesar de sua importância, causa complicações e o seu uso é identificado como um dos principais fatores de lesão pulmonar em prematuros, principalmente displasia broncopulmonar [1][2][3] . Embora reconhecida a importância da redução do tempo de utilização da VPM invasiva, este é um processo complexo, sendo influenciado por muitos fatores, como os diferentes estágios de desenvolvimento pulmonar, a doença de base, complicações secundárias, interações cardiorrespiratórias e a relação entre o controle central da respiração e os músculos respiratórios 4 .…”

Section: Introductionunclassified

Practices of use of nasal intermittent positive pressure ventilation (NIPPV) in neonatology in northeastern Brazil

Medeiros¹,

Carvalho²,

Soriano³

2012

J Pediatr (Rio J)

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Objective: To investigate the use of nasal intermittent positive pressure ventilation (NIPPV) in level three neonatal intensive care units (NICU) in northeastern Brazil. Methods:This observational cross-sectional survey was conducted from March 2009 to January 2010 in all level three NICUs in northeastern Brazil that are registered in the Brazilian Registry of Health Establishments (Cadastro Nacional de Estabelecimentos de Saúde, CNES) of the Ministry of Health. Questionnaires about the use of NIPPV were sent to the NICU directors in each institution. Statistical analysis was conducted using the software Epi-Info 6.04 and double data entry. A chi-square test was used to compare variables, and the level of statistical significance was set at p ≤ 0.05. Results: This study identified 93 level three NICUs in northeasternBrazil registered in CNES, and 87% answered the study questionnaire. ResumoObjetivo: Conhecer as práticas referentes ao uso de ventilação por pressão positiva intermitente nasal (VPPIN) em unidades terciárias de atendimento neonatal do Nordeste brasileiro.Métodos: Estudo observacional seccional tipo inquérito, realizado entre março de 2009 e janeiro de 2010 em todas as instituições de atendimento neonatal de nível terciário localizadas no Nordeste brasileiro, cadastradas no Conselho Nacional dos Estabelecimentos de Saúde (CNES) do Ministério de Saúde. Realizado por meio de levantamento, utilizando questionários sobre o uso de VPPIN, enviados aos responsáveis das unidades de cuidados intensivos neonatais de cada instituição. A análise estatística foi realizada pelo software Epi-Info versão 6.04, com dupla entrada de dados. As variáveis foram comparadas pelo teste do qui-quadrado, sendo considerado nível de significância de 5%.Resultados: Estão cadastradas no CNES 93 unidades terciárias neonatais no Nordeste brasileiro. Os questionários foram respondidos por 87% delas. A maior parte classificou-se como de natureza privada (30,7%) ou pública estadual (29,4%). O número de instituições que se utilizam da VPPIN correspondeu a 98,7% do total. Grande parte das unidades (92,8 %) declarou utilizar aparelhos de ventilação pulmonar mecânica, adaptados para aplicação de VPPIN, e pronga binasal curta como interface (94,2%). O protocolo para aplicação de VPPIN existia em apenas 17,3% das unidades. A média dos valores de pressão positiva inspiratória adotados foi de 20,0 cmH 2 O (desvio padrão = 4,47) e de pressão expiratória final positiva foi de 5,0 cmH 2 O (desvio padrão = 0,84). Conclusão:A VPPIN representa um suporte utilizado pelas unidades neonatais no Nordeste brasileiro, embora se observe pouca uniformização quanto às indicações e parâmetros adotados entre as instituições. J Pediatr (Rio J). 2012;88(1):48-53:Respiração artificial, neonatologia, unidade de terapia intensiva, recém-nascido. Practices of use of nasal intermittent positive pressure ventilation (NIPPV) in neonatology in northeastern Brazil

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“…12 Although it is difficult to decouple and evaluate the injurious effects related to the ETT from those of the ventilator, the ETT is probably a major factor adding to causal respiratory failure and injury during invasive ventilation. Endotracheal intubation is a traumatic and painful procedure that requires sedation and can be associated with hemodynamic instabilities, airway emergencies, acute airway injury, colonization of the trachea, reduced ciliary movement, secretions, high resistance to air flow, and increased WOB.…”

Section: Introductionmentioning

confidence: 99%

Neonatal Noninvasive Ventilation Techniques: Do We Really Need to Intubate?

DiBlasi

2011

Respir Care

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Non-invasive positive pressure ventilation in the preterm neonate: reducing endotrauma and the incidence of bronchopulmonary dysplasia

Cited by 39 publications

References 52 publications

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

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

Practices of use of nasal intermittent positive pressure ventilation (NIPPV) in neonatology in northeastern Brazil

Neonatal Noninvasive Ventilation Techniques: Do We Really Need to Intubate?

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