The Importance of Synchronization During Neonatal Noninvasive Ventilation

DiBlasi, Robert M

doi:10.4187/respcare.06741

Cited by 3 publications

(2 citation statements)

References 42 publications

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“…The following alterations to the pre-set scripts were made for this study: for the preemie and newborn models, compliance was set at 0.5 mL/cm H 2 O, resistance was set at 100 cm H 2 O/L/s, and breathing frequency was set at 40 breaths/min; for the infant model, compliance was set at 1.5 mL/cm H 2 O, resistance was set at 50 cm H 2 O/L/s, and breathing frequency was set at 30 breaths/min. 12,13 A Dra ¨ger V500 ventilator (Dra ¨ger Medical) was set in CPAP mode with leak compensation turned on. Nine PEEP levels (5,6,8,10,12,14,16,18, and 20 cm H 2 O) were tested for 3 min each to allow for system equilibration.…”

Section: Study Design and Setupmentioning

confidence: 99%

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Performance Evaluation of Nasal Prong Interface for CPAP Delivery on a Critical Care Ventilator: A Bench Experiment

et al. 2021

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BACKGROUND: The RAM cannula (Neotech, Valencia, CA) has become a commonly used interface for CPAP in neonatal intensive care. Performance characteristics of this interface used with a critical care ventilator are not well described. METHODS: This was a bench study utilizing a lung simulator configured as an actively breathing infant (weights of 800 g, 1.5 kg, and 3 kg) with moderate lung disease and a critical care ventilator in CPAP mode with leak compensation on. Three sizes of the RAM cannulae (preemie, newborn, and infant) were compared to 3 BabyFlow nasal prongs (Dra ¨ger Medical, Lu ¨beck, Germany) (medium, large, and extra-large). Fabricated nasal models produced a 70% occlusive fit for the RAM cannula and an occlusive fit with the Dra ¨ger prongs. Delivered flow and pressure levels were recorded at 9 CPAP levels between 5 and 20 cm H 2 O. RESULTS: The Dra ¨ger prongs produced a mean airway pressure (P aw ) within 0.20 cm H 2 O (range -0.10 to 0.35) of the set CPAP across all evaluated prong sizes and CPAP levels. In contrast, the RAM cannula produced P aw values that averaged 8.5 cm H 2 O (range -15 to -3.5) below the set CPAP levels. The deficit in delivered versus target CPAP level for the RAM cannula increased with greater set CPAP. Set CPAP of 5 cm H 2 O delivered P aw values that ranged from 0.6 to 1.5 cm H 2 O (difference of 3.5-4.4 cm H 2 O). Set CPAP of 20 cm H 2 O delivered P aw values that ranged from 5.0 to 8.4 cm H 2 O (difference of 11.7-15 cm H 2 O). Inspiratory flow required to achieve set CPAP levels did not differ between interfaces, suggesting high resistance in the RAM cannula device masks the delivered CPAP levels. CONCLUSIONS: Use of the RAM cannula with a 30% leak on a critical care ventilator delivered P aw values lower than set CPAP. This may be clinically meaningful and should be considered when choosing a nasal interface.

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Section: Study Design and Setupmentioning

confidence: 99%

“…12,13 A Dra ¨ger V500 ventilator (Dra ¨ger Medical) was set in CPAP mode with leak compensation turned on. Nine PEEP levels (5,6,8,10,12,14,16,18, and 20 cm H 2 O) were tested for 3 min each to allow for system equilibration. Data abstracted from the last 5 breaths were utilized for the analyses.…”

Section: Study Design and Setupmentioning

confidence: 99%

Performance Evaluation of Nasal Prong Interface for CPAP Delivery on a Critical Care Ventilator: A Bench Experiment

et al. 2021

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Feasibility of synchronized high flow nasal cannula

Matlock,

Beck,

et al. 2024

Pediatric Pulmonology

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BackgroundA high‐flow nasal cannula (cHFNC) delivers flow continuously (during inspiration and expiration). Using the diaphragm electrical activity (Edi), synchronizing HFNC could be an alternative (cycling high/low flow on inspiration/expiration, respectively). The objective of this study was to demonstrate the feasibility of synchronized HFNC (sHFNC) and compare it to cHFNC.MethodsDifferent levels of cHFNC and sHFNC (4, 6, 8, and 10 liters per minute [LPM], with 2 LPM on expiration for sHFNC) were compared in eight rabbits (mean weight 3.16 kg), before and after acute lung injury (pre‐ALI and post‐ALI). Edi, tracheal pressure (Ptr), esophageal pressure (Pes), flow, and arterial CO2 were measured. In addition to the animal study, one 3.52 kg infant received sHFNC and cHFNC using a Servo‐U ventilator.ResultsIn the animal study, there were more pronounced decreases in Edi, reduced Pes swings and reduced PaCO2 at comparable flows during sHFNC compared to cHFNC both pre and post‐ALI (p < .05). Baseline (pre‐inspiratory) Ptr was 2−7 cmH2O greater during cHFNC (p < .05) indicating more dynamic hyperinflation. In one infant, the ventilator performed as expected, delivering Edi‐synchronized high/low flow.ConclusionSynchronizing high flow unloaded breathing, decreased Edi, and reduced PaCO2 in an animal model and is feasible in infants.

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Changes in Electrical Activity of the Diaphragm in Response to Painful Procedures in Neonates

et al. 2020

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Background: Premature neonates are exposed to numerous painful procedures. Physiologic fluctuations in heart rate (HR), respiratory rate, and oxygen saturation are typically used to determine the response to pain. Neurally assisted ventilatory assist (NAVA) delivers inspiratory pressure in proportion to the electrical activity of the diaphragm (Edi). Since NAVA allows self-regulation of peak inspiratory pressures (PIP), there is apprehension that painful stimulus may increase respiratory drive and result in ex- cessive PIP. This study evaluated changes in respiratory drive, measured by Edi, in response to a painful procedure (heel stick) to determine if there was excessive PIP delivered from the ventilator. Methods: Prospective, single-center study; subjects <32 weeks on NAVA/NIV NAVA requiring routine blood work via heel sticks. Vital signs were measured every 10 seconds for the first 2 minutes. PIP, Edi peak, and min were collected for the first ten breaths and then averaged at 1 and 2 minutes. Statistics were repeated measures ANOVA. Results: Fourteen subjects with gestational age 26.9+2 weeks and birth weight 994+318 grams. At study, the average age was 4.6+5 days, and weight was 948+305 grams. Following the heel stick, the first breath showed an increase in PIP and Edi peak but returned to baseline by the second breath. PIP increased again by the10th breath and at 1 and 2 minutes. HR increased after heel stick and remained elevated through the remainder of the study. There were no changes in tonic Edi, Edi min or other vital signs. Conclusion: Although the increase in PIP and Edi peak in response to heel stick pain was brief and limited, it is important always to set the PIP alarm limit appropriately to protect the lung from excessive pressures that may be generated during painful procedures.

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The Importance of Synchronization During Neonatal Noninvasive Ventilation

Cited by 3 publications

References 42 publications

Performance Evaluation of Nasal Prong Interface for CPAP Delivery on a Critical Care Ventilator: A Bench Experiment

Performance Evaluation of Nasal Prong Interface for CPAP Delivery on a Critical Care Ventilator: A Bench Experiment

Feasibility of synchronized high flow nasal cannula

Changes in Electrical Activity of the Diaphragm in Response to Painful Procedures in Neonates

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