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

Abstract

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

Prevalencia de lesao do septo nasal em prematuros no uso de prongas nasais

“…This type of ventilatory support is an effective alternative to reduce the time of transition from mechanical ventilation to spontaneous breathing in the treatment of respiratory distress of premature babies (4) . Some devices are used for application of this system, such as face mask, nasal mask, tracheal tube, intubation, short single nasal prong, nasopharyngeal prong and short binasal prong, which is the most widely used in health services for its easy application in neonatal clientele, especially in Northeastern Brazil (4)(5)(6) .…”

Respiratory Care Protocols in Neonatal Intensive Care

“…Nasal intermittent positive pressure ventilation (NIPPV) -This has also gained popularity, with rates of use varying from 18 to 88% in different parts of the world [25][26][27][28]. It is most commonly applied as a rescue mode for infants who fail CPAP, to prevent intubation in infants with RDS or immediately after extubation.…”

“…This variability in usage mainly stems from conflicting evidence on its effectiveness as well as limited understanding of its mechanisms of action, clinical indications and optimal means of delivering the pressures. Similar to CPAP, units may have at their disposal up to five different devices and interfaces for delivering NIPPV [26][27][28]. Synchronized NIPPV is still used by some units, but for the majority it is no longer commercially available [27,28].…”

“…Similar to CPAP, units may have at their disposal up to five different devices and interfaces for delivering NIPPV [26][27][28]. Synchronized NIPPV is still used by some units, but for the majority it is no longer commercially available [27,28]. This is particularly important because the only studies demonstrating physiological and clinical benefits have used synchronized NIPPV [28].Furthermore, there is no consensus on what constitutes best settings (peak inflation pressure, PEEP and rate) and how to optimally wean NIPPV.…”

“…In another international survey, 36% of units reported having a guideline or written protocol for ventilator weaning [23]. Protocols for CPAP and NIPPV are available in approximately 20% of units [16,27,28], while guidelines for HFNC are present in 25-50% of units [16,29,30].…”