Noninvasive Ventilation In Neonates

Objectives

Techniques

Response To NIV

Clinical indications

Contraindications

Evidence Based Decisions

Techniques

1. CPAP

2. BiPAP

3. SNIPPV

4. HHHFNC

CPAP• Constant level of pressure support to the airways

during inspiration and expiration

• 5-10 cm H2O and up to 15

• Recomended NCPAP is 7 cm H2O

• Different external interfaces

• Hypoxemic respiratory failure

External interfaces

BiPAP• Provide two levels of positive airway pressure

during the respiratory cycle• Higher level (IPAP): “2-25” cm H2O ≈ “10 -16” cm

H2O • Lower level(EPAP): “2-20” cm H2O ≈ “5 to 10” cm

H2O• Leak compensation• Hypercapnic respiratory failure• Comes in 3 types:

1. PS: pt. trigger2. PC: set RR3. BiPAP: IPAP +EPAP.

SNIPPV

• Augmenting NCPAP (delivering ventilator breaths via nasal prongs).

• Improves ( tidal volume, minute ventilation) and decrease WOB compared to NCPAP.

• Intermittent peak inspiratory pressure.

HHHFNC

• “HHFNC* provides airway-distending pressure and respiratory support in preterm neonates comparable to nasal CPAP” (Saslow et al., 2006).

• Hypoxemic respiratory failure

• Flow rate 1-8 L/min for neonates

• Oxygen blinder

• FiO2 up to 1.0

Is it working ?

Response To NIV

Clinical indications

Contraindications

Techniques

Response To NIV

Clinical indications

Contraindications

Evidence Based Decisions

RDS :

•No differences between NSIPPV and BiPAP strategies in terms of duration of ventilation and failures, suggesting that both NIV techniques are effective in the early treatment of RDS in VLBW infants.

RDS:

•HHFNC is well-tolerated by premature infants. Compared to infants managed with NCPAP.

•No differences in deaths, ventilator-days, BPD, blood infections or other outcomes. More infants were intubated for failing early NCPAP compared to early HHFNC

Hypoxic respiratory failure:

•In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients.

AOP (HFNC vs. NCPAP)

AOP:

•HFNC is as effective as NCPAP in the management of AOP.

• NIPPV appears to reduce the frequency of apneas more effectively than NCPAP

Post Extubation:

•HHHFNC appears to have similar efficacy and safety to NCPAP when applied immediately post extubation

• The meta-analysis demonstrates a statistically and clinically significant reduction in the risk of meeting extubation failure criteria

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