Abstract
Respiratory support for preterm neonates in modern neonatal intensive care units is
predominantly with the use of noninvasive interfaces. Continuous positive airway pressure
(CPAP) and nasal intermittent positive pressure ventilation (NIPPV) are the prototypical
and most commonly utilized forms of noninvasive respiratory support, and each has
unique gas flow characteristics. In meta-analyses of clinical trials till date, NIPPV
has been shown to likely reduce respiratory failure and need for intubation compared
to CPAP. However, a significant limitation of the included studies has been the higher
mean airway pressures used during NIPPV. Thus, it is unclear to what extent any benefits
seen with NIPPV are due to the cyclic pressure application versus the higher mean
airway pressures. In this review, we elaborate on these limitations and summarize
the available evidence comparing NIPPV and CPAP at equivalent mean airway pressures.
Finally, we call for further studies comparing noninvasive respiratory support modes
at equal mean airway pressures.
Key Points
Most current literature on CPAP vs. NIPPV in preterm neonates is confounded by use
of higher mean airway pressures during NIPPV.
In this review, we summarize existing evidence on CPAP vs. NIPPV at equivalent mean
airway pressures.
We call for future research on noninvasive support modes to account for mean airway
pressures.
Keywords noninvasive respiratory support - CPAP - NIPPV - distending pressure - future research
