Synchronized Nasal Intermittent Positive Pressure Ventilation

Moretti, Corrado; Gizzi, Camilla

doi:10.1016/j.clp.2021.07.005

Cited by 11 publications

(16 citation statements)

References 41 publications

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“…Ventilator inflations can be synchronised with the infant’s breathing by using either an abdominal capsule or in-line sensors. Synchronisation of nasal ventilation further improves respiratory stability [113]. Recent systematic reviews comparing different modes of NIV for primary respiratory support or post-extubation concluded that synchronised NIPPV was the most effective, decreasing the need for MV, or re-ventilation, in preterm infants [114, 115].…”

Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of “European Guidelines for the Management of RDS” by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

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Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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“…The disadvantages of a pressure trigger for sNIPPV is its low sensitivity, causing frequent auto-triggering or no triggering; auto-triggering caused by secretions or leaks; and the lack of flow monitoring. 5 Fifth, no washout period was implemented during the crossover intervention; however, an This article is protected by copyright. All rights reserved.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…However, in the past decade, synchronized nasal intermittent positive pressure ventilation (sNIPPV) and nasal high-frequency oscillatory ventilation (nHFOV) have been increasingly utilized in neonatal medicine. 4 sNIPPV is used to deliver synchronized intermittent positive pressure during the inspiratory phase 5 and nHFOV is used to generate oscillation without synchrony over continuous positive airway pressure. 6 In a meta-analysis, sNIPPV (9.4% [17/180]) was shown to more efficacious than nCPAP (39.5% [68/172]) in preventing postextubation failure.…”

mentioning

confidence: 99%

Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial

Baingam,

Phatigomet,

Thatrimontrichai

et al. 2023

Am J Perinatol

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Objective Nasal high-frequency oscillatory ventilation (nHFOV) and synchronized nasal intermittent positive pressure ventilation (sNIPPV) yield a lower partial pressure of CO2 (pCO2) after extubation than nasal continuous positive airway pressure. Our aim was to clarify which of the two was superior. Study Design We performed a crossover randomized study to evaluate pCO2 level among 102 participants from July 2020 to June 2022. Intubated preterm and term neonates with arterial lines were randomly allocated to nHFOV-sNIPPV or sNIPPV-nHFOV sequences; their pCO2 levels were measured after 2 h in each mode. Subgroup analyses were performed for preterm (gestational age <37 weeks) and very preterm (gestational age <32 weeks) neonates. Results The mean gestational age (nHFOV-sNIPPV, 32.8 vs sNIPPV-nHFOV, 33.5 weeks) and median birth weight (1,850 vs 1,930 g) did not differ between the sequences. The mean ± standard deviation pCO2 level after nHFOV (38.7 ± 8.8 mmHg) was significantly higher than that after sNIPPV (36.8 ± 10.2 mmHg; mean difference: 1.9 mmHg; 95% confidence interval: 0.3–3.4; treatment effect [p = 0.007] but no sequence [p = 0.92], period [p = 0.53], or carryover [p = 0.94] effects). However, the difference of pCO2 level between the sequences was not statistically significant in the subgroup analyses of preterm and very preterm neonates. Conclusion After neonatal extubation, the sNIPPV mode was associated with a lower pCO2 level than the nHFOV mode with no significant difference in preterm and very preterm neonates.

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“…Others have not found SNIPPV vs NIPPV to be associated with a differential impact on clinical outcomes [36]. In this study, nonsynchronized NIPPV was used because of the lack of availability of the appropriate ventilator, which is the most commonly used mode of NIPPV in neonatal practice [34,36].…”

Section: Ramos-navarro Et Almentioning

confidence: 97%

“…Preterm birth at such a critical time of lung development, along with very low BW, are important factors that may contribute to the inadequate response to rescue NIPPV. Some authors support that synchronized NIPPV (SNIPPV) may further improve NIPPV efficacy with more efficient positive pressure transmission to the lung and better stabilization of the chest wall during inspiration, reducing intubation rates [34,35]. Others have not found SNIPPV vs NIPPV to be associated with a differential impact on clinical outcomes [36].…”

Section: Ramos-navarro Et Almentioning

confidence: 99%

Nasal intermittent positive pressure ventilation as a rescue therapy after nasal continuous positive airway pressure failure in infants with respiratory distress syndrome

et al. 2023

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Objective: Evaluate whether nasal intermittent positive-pressure ventilation (NIPPV) as rescue therapy after initial nasal continuous positive airway (NCPAP) failure reduces need for invasive mechanical ventilation (IMV) in infants with respiratory distress syndrome (RDS). Design: Retrospective cohort involving 156 preterm infants who failed initial NCPAP and were then submitted to NIPPV rescue therapy and classified into NIPPV success or failure, according to need for IMV. Result: Of all infants included, 85 (54.5%) were successfully rescued with NIPPV while 71 (45.5%) failed.The NIPPV success group had significantly lower rates of bronchopulmonary dysplasia, peri/intraventricular hemorrhage, patent ductus arteriosus and greater survival without morbidities (all p≤0.01). Infants who failed NIPPV had earlier initial NCPAP failure (p=0.09). In final logistic regression model, birthweight ≤1000 g and need for surfactant remained significant factors for NIPPV failure. Conclusion: NIPPV rescue therapy reduced the need for IMV in infants that failed NCPAP and was associated with better outcomes.

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Synchronized Nasal Intermittent Positive Pressure Ventilation

Cited by 11 publications

References 41 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial

Nasal intermittent positive pressure ventilation as a rescue therapy after nasal continuous positive airway pressure failure in infants with respiratory distress syndrome

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