Download PDF
AJP Rep 2016; 06(03): e264-e271
DOI: 10.1055/s-0036-1586205
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effectiveness of Synchronized Noninvasive Ventilation to Prevent Intubation in Preterm Infants

Cristina Ramos-Navarro
1   Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
,
Manuel Sanchez-Luna
1   Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
,
Ester Sanz-López
1   Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
,
Elena Maderuelo-Rodriguez
1   Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
,
Elena Zamora-Flores
1   Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
› Author Affiliations
Further Information

Publication History

05 March 2016

14 June 2016

Publication Date:
04 August 2016 (online)

   Permissions and Reprints

Abstract

Background Noninvasive ventilation is being increasingly used on preterm infants to reduce ventilator lung injury and bronchopulmonary dysplasia. The aim of this study was to evaluate the effectiveness of synchronized nasal intermittent positive pressure ventilation (SNIPPV) to prevent intubation in premature infants.

Methods Prospective observational study of SNIPPV use on preterm infants of less than 32 weeks' gestation. All patients were managed using a prospective protocol intended to reduce invasive mechanical ventilation (iMV) use. Previous respiratory status, as well as respiratory outcomes and possible secondary side effects were analyzed.

Results SNIPPV was used on 78 patients: electively to support extubation on 25 ventilator-dependent patients and as a rescue therapy after nasal continuous positive airway pressure failure on 53 patients. For 92% of patients in the elective group and 66% in the rescue group, iMV was avoided over the following 72 hours. No adverse effects were detected, and all patients were in a stable condition even if intubation was eventually needed.

Conclusions The application of SNIPPV in place of or to remove mechanical ventilation avoids intubation in 74.4% of preterm infants with respiratory failure. No adverse effects were detected.

Keywords

synchronized noninvasive ventilation - preterm infants - nCPAP failure - extubation failure

Note

Approval for this study was obtained from the Local Ethics Committee.


 

  • References

  • 1 Wright CJ, Kirpalani H. Targeting inflammation to prevent bronchopulmonary dysplasia: can new insights be translated into therapies?. Pediatrics 2011; 128 (1) 111-126
    CrossrefPubMedGoogle Scholar
  • 2 van Kaam A. Lung-protective ventilation in neonatology. Neonatology 2011; 99 (4) 338-341
    CrossrefPubMedGoogle Scholar
  • 3 Hillman NH, Moss TJ, Kallapur SG , et al. Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep. Am J Respir Crit Care Med 2007; 176 (6) 575-581
    CrossrefPubMedGoogle Scholar
  • 4 Frank JA, Parsons PE, Matthay MA. Pathogenetic significance of biological markers of ventilator-associated lung injury in experimental and clinical studies. Chest 2006; 130 (6) 1906-1914
    CrossrefPubMedGoogle Scholar
  • 5 Gharib SA, Liles WC, Klaff LS, Altemeier WA. Noninjurious mechanical ventilation activates a proinflammatory transcriptional program in the lung. Physiol Genomics 2009; 37 (3) 239-248
    CrossrefPubMedGoogle Scholar
  • 6 Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB ; COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358 (7) 700-708
    CrossrefPubMedGoogle Scholar
  • 7 Bose CL, Laughon MM, Allred EN , et al; ELGAN Study Investigators. Systemic inflammation associated with mechanical ventilation among extremely preterm infants. Cytokine 2013; 61 (1) 315-322
    CrossrefPubMedGoogle Scholar
  • 8 Jobe AH, Kramer BW, Moss TJ, Newnham JP, Ikegami M. Decreased indicators of lung injury with continuous positive expiratory pressure in preterm lambs. Pediatr Res 2002; 52 (3) 387-392
    CrossrefPubMedGoogle Scholar
  • 9 Hillman NH, Nitsos I, Berry C, Pillow JJ, Kallapur SG, Jobe AH. Positive end-expiratory pressure and surfactant decrease lung injury during initiation of ventilation in fetal sheep. Am J Physiol Lung Cell Mol Physiol 2011; 301 (5) L712-L720
    CrossrefPubMedGoogle Scholar
  • 10 Finer NN, Carlo WA, Walsh MC , et al; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362 (21) 1970-1979
    CrossrefPubMedGoogle Scholar
  • 11 Dunn MS, Kaempf J, de Klerk A , et al; Vermont Oxford Network DRM Study Group. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics 2011; 128 (5) e1069-e1076
    CrossrefPubMedGoogle Scholar
  • 12 Meneses J, Bhandari V, Alves JG, Herrmann D. Noninvasive ventilation for respiratory distress syndrome: a randomized controlled trial. Pediatrics 2011; 127 (2) 300-307
    CrossrefPubMedGoogle Scholar
  • 13 Committee on Fetus and Newborn; American Academy of Pediatrics. Respiratory support in preterm infants at birth. Pediatrics 2014; 133 (1) 171-174
    CrossrefPubMedGoogle Scholar
  • 14 Sweet DG, Carnielli V, Greisen G , et al; European Association of Perinatal Medicine. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants—2013 update. Neonatology 2013; 103 (4) 353-368
    CrossrefPubMedGoogle Scholar
  • 15 Ammari A, Suri M, Milisavljevic V , et al. Variables associated with the early failure of nasal CPAP in very low birth weight infants. J Pediatr 2005; 147 (3) 341-347
    CrossrefPubMedGoogle Scholar
  • 16 Dargaville PA, Aiyappan A, De Paoli AG , et al. Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences. Neonatology 2013; 104 (1) 8-14
    CrossrefPubMedGoogle Scholar
  • 17 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (7) 1723-1729
    CrossrefPubMedGoogle Scholar
  • 18 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
    CrossrefPubMedGoogle Scholar
  • 19 Cummings JJ, Polin RA ; Committee on Fetus and Newborn, American Academy of Pediatrics. Noninvasive respiratory support. Pediatrics 2016; 137 (1) 1-11
    CrossrefPubMedGoogle Scholar
  • 20 Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics 2001; 107 (4) 638-641
    Google Scholar
  • 21 Friedlich P, Lecart C, Posen R, Ramicone E, Chan L, Ramanathan R. A randomized trial of nasopharyngeal-synchronized intermittent mandatory ventilation versus nasopharyngeal continuous positive airway pressure in very low birth weight infants after extubation. J Perinatol 1999; 19 (6 Pt 1): 413-418
    CrossrefPubMedGoogle Scholar
  • 22 Khalaf MN, Brodsky N, Hurley J, Bhandari V. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics 2001; 108 (1) 13-17
    Google Scholar
  • 23 Moretti CPP, Gizzi C , et al. Flow-synchronized nasal intermittent positive pressure ventilation in the preterm infant: development of a project. J Pediatr Neonatal Individualized Med 2013; 2: e020211 . Doi: 10.7363/020211
    PubMedGoogle Scholar
  • 24 Moretti C, Gizzi C, Papoff P , et al. Comparing the effects of nasal synchronized intermittent positive pressure ventilation (nSIPPV) and nasal continuous positive airway pressure (nCPAP) after extubation in very low birth weight infants. Early Hum Dev 1999; 56 (2–3) 167-177
    CrossrefPubMedGoogle Scholar
  • 25 Moretti C, Giannini L, Fassi C, Gizzi C, Papoff P, Colarizi P. Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: unmasked randomized controlled trial. Pediatr Int 2008; 50 (1) 85-91
    Google Scholar
  • 26 Gizzi C, Papoff P, Giordano I , et al. Flow-synchronized nasal intermittent positive pressure ventilation for infants <32 weeks' gestation with respiratory distress syndrome. Crit Care Res Pract 2012; 2012: 301818
    PubMedGoogle Scholar
  • 27 Gizzi C, Montecchia F, Panetta V , et al. Is synchronised NIPPV more effective than NIPPV and NCPAP in treating apnoea of prematurity (AOP)? A randomised cross-over trial. Arch Dis Child Fetal Neonatal Ed 2015; 100 (1) F17-F23
    Google Scholar
  • 28 Badiee Z, Nekooie B, Mohammadizadeh M. Noninvasive positive pressure ventilation or conventional mechanical ventilation for neonatal continuous positive airway pressure failure. Int J Prev Med 2014; 5 (8) 1045-1053
    PubMedGoogle Scholar
  • 29 Kattwinkel J, Perlman JM, Aziz K , et al; American Heart Association. Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2010; 126 (5) e1400-e1413
    CrossrefPubMedGoogle Scholar
  • 30 Ryan RM. A new look at bronchopulmonary dysplasia classification. J Perinatol 2006; 26 (4) 207-209
    CrossrefPubMedGoogle Scholar
  • 31 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
    CrossrefPubMedGoogle Scholar
  • 32 Lemyre B, Davis PG, De Paoli AG, Kirpalani H. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev 2014; 9 (9) CD003212
    PubMedGoogle Scholar
  • 33 Nesbitt G, Guy KJ, König K. Unplanned extubation and subsequent trial of noninvasive ventilation in the neonatal intensive care unit. Am J Perinatol 2015; 32 (11) 1059-1063
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Ramos-Navarro C, Sánchez-Luna M, Zeballos-Sarrato S, González-Pacheco N. Less invasive beractant administration in preterm infants: a pilot study. Clinics (Sao Paulo) 2016; 71 (3) 128-134
    CrossrefPubMedGoogle Scholar
  • 35 Ryan CA, Finer NN, Peters KL. Nasal intermittent positive-pressure ventilation offers no advantages over nasal continuous positive airway pressure in apnea of prematurity. Am J Dis Child 1989; 143 (10) 1196-1198
    Google Scholar
  • 36 Owen LS, Morley CJ, Dawson JA, Davis PG. Effects of non-synchronised nasal intermittent positive pressure ventilation on spontaneous breathing in preterm infants. Arch Dis Child Fetal Neonatal Ed 2011; 96 (6) F422-F428
    CrossrefPubMedGoogle Scholar
  • 37 Huang L, Mendler MR, Waitz M, Schmid M, Hassan MA, Hummler HD. Effects of synchronization during noninvasive intermittent mandatory ventilation in preterm infants with respiratory distress syndrome immediately after extubation. Neonatology 2015; 108 (2) 108-114
    CrossrefPubMedGoogle Scholar
  • 38 Chang HY, Claure N, D'ugard C, Torres J, Nwajei P, Bancalari E. Effects of synchronization during nasal ventilation in clinically stable preterm infants. Pediatr Res 2011; 69 (1) 84-89
    CrossrefPubMedGoogle Scholar
  • 39 Praud JP, Samson N, Moreau-Bussière F. Laryngeal function and nasal ventilatory support in the neonatal period. Paediatr Respir Rev 2006; 7 (Suppl. 01) S180-S182
    CrossrefPubMedGoogle Scholar
  • 40 Hutchison AA, Bignall S. Non-invasive positive pressure ventilation in the preterm neonate: reducing endotrauma and the incidence of bronchopulmonary dysplasia. Arch Dis Child Fetal Neonatal Ed 2008; 93 (1) F64-F68
    CrossrefPubMedGoogle Scholar
  • 41 Moreau-Bussière F, Samson N, St-Hilaire M , et al. Laryngeal response to nasal ventilation in nonsedated newborn lambs. J Appl Physiol (1985) 2007; 102 (6) 2149-2157
    CrossrefPubMedGoogle Scholar