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Roehr CC, Farley HJ, Mahmoud RA, Ojha S. Non-Invasive Ventilatory Support in Preterm Neonates in the Delivery Room and the Neonatal Intensive Care Unit: A Short Narrative Review of What We Know in 2024. Neonatology 2024; 121:576-583. [PMID: 39173610 PMCID: PMC11446298 DOI: 10.1159/000540601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Guidelines recommend non-invasive ventilatory (NIV) support as first-line respiratory support mode in preterm infants as NIV is superior to intubation and mechanical ventilation in preventing death or bronchopulmonary dysplasia. However, with an ever-expanding variety of NIV modes available, there is much debate about which NIV modality should ideally be used, how, and when. The aims of this work were to summarise the evidence on different NIV modalities for both primary and secondary respiratory support: nCPAP, nasal high-flow therapy (nHFT), and nasal intermittent positive airway pressure ventilation (nIPPV), bi-level positive airway pressure (BiPAP), nasal high-frequency oscillatory ventilation (nHFOV), and nasally applied, non-invasive neurally adjusted ventilatory assist (NIV-NAVA) modes, with particular focus on their use in preterm infants. SUMMARY This is a narrative review with reference to published guidelines by European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. nCPAP is currently the most commonly used primary and secondary NIV modality for premature infants. However, there is increasing evidence on the superiority of nIPPV over nCPAP. No beneficial effect was found for BiPAP over nCPAP. For the use of nHFT, nHFOV, and NIV-NAVA, more studies are needed to establish their place in neonatal respiratory care. KEY MESSAGES The superiority of nIPPV over nCPAP needs to be confirmed by contemporaneous trials comparing nCPAP to nIPPV at comparable mean airway pressures. Future trials should study NIV modalities in preterm infants with comparable respiratory pathology and indications, at comparable pressure settings and with different modes of synchronisation. Importantly, future trials should not exclude infants of the smallest gestational ages.
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Affiliation(s)
- Charles C Roehr
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK,
- Faculty of Health Sciences, University of Bristol, Bristol, UK,
- Newborn Care, Southmead Hospital, North Bristol Trust, Bristol, UK,
| | - Hannah J Farley
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Ramadan A Mahmoud
- Department of Pediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Shalini Ojha
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
- Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Ribeiro DDFC, Hembecker PK, Nakato AM, Fernandes BL, Nohama P. Satisfaction of Health Professionals Regarding the Short Binasal Prong Used as a Non-Invasive Ventilation Interface in Neonatology. J Multidiscip Healthc 2023; 16:2217-2229. [PMID: 37551341 PMCID: PMC10404407 DOI: 10.2147/jmdh.s415748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023] Open
Abstract
Purpose To evaluate the health professionals' satisfaction regarding the short binasal prong used in Neonatal Intensive Care Units (NICU), evaluate the difficulties related to its use, and present possible improvements in the design of this device. Patients and Methods Observational, cross-sectional study with prospective data collection carried out in the NICU of a public hospital in southern Brazil. This research was presented into two stages. In the first stage, the Quebec User Evaluation of Satisfaction with Assistive Technology was applied with 90 health professionals to evaluate the satisfaction regarding the short binasal prong. In the second stage, the health professional's experiences and difficulties in using the binasal prongs in 14 newborns (NBs) that required non-invasive ventilation was collected. The short binasal prongs used was the Fanem® brand and the CPAP circuit was Gabisa Medical International (GMI®). Finally, improvements and recommendations were presented to optimize the device's design. Results The mean score of the health professionals' satisfaction with short binasal prongs was 3.8 ± 0.6. Ease of adjustment (3.27) and dimensions (3.62) variables had the worst scores. The main difficulties pointed out by health professionals were: circuit disconnection (57.1%), the size of the prong did not correspond to NBs' anatomical characteristics (35.7%), air leakage (21.4%), and difficulty in fixing and positioning the prong in the NB (14.28%). The improvements suggested were: appropriate prong sizes based on the anatomical characteristics of the NBs; adjustable distance between insertion and base catheters; manufactured with malleable material, however not easily foldable; curved and adjustable insertion catheters and functional system of tracheas' connection. Conclusion The dissatisfaction of health professionals with the dimensions and prongs adjustments and the difficulties faced in clinical practice indicate the need for improvements in these interfaces. The recommendations presented in this study may contribute to optimizing the design of the binasal prong in the future.
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Affiliation(s)
- Débora de Fátima Camillo Ribeiro
- Neonatal Services, Waldemar Monastier Hospital, Campo Largo, Paraná, Brazil
- Graduate Program on Health Technology, Pontifícia Universidade Católica Do Paraná, Curitiba, Paraná, Brazil
| | - Paula Karina Hembecker
- Graduate Program on Health Technology, Pontifícia Universidade Católica Do Paraná, Curitiba, Paraná, Brazil
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica Do Paraná, Curitiba, Paraná, Brazil
| | - Beatriz Luci Fernandes
- Graduate Program on Health Technology, Pontifícia Universidade Católica Do Paraná, Curitiba, Paraná, Brazil
| | - Percy Nohama
- Graduate Program on Health Technology, Pontifícia Universidade Católica Do Paraná, Curitiba, Paraná, Brazil
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal Do Paraná, Curitiba, Paraná, Brazil
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Falk M, Gunnarsdottir K, Baldursdottir S, Donaldsson S, Jonsson B, Drevhammar T. Interface leakage during neonatal CPAP treatment: a randomised, cross-over trial. Arch Dis Child Fetal Neonatal Ed 2021; 106:663-667. [PMID: 33963004 PMCID: PMC8543197 DOI: 10.1136/archdischild-2021-321579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine leakage for two neonatal continuous positive airway pressure (CPAP) interfaces and evaluate leak-corrective manoeuvres. DESIGN The ToNIL (Trial of NCPAP Interface Leakage) study was a randomised, clinical, cross-over trial with data collection between August 2018 and October 2019. The primary outcome was blinded to the treating staff. SETTING One secondary, 8-bed neonatal intensive care unit (NICU) and three larger (>15 beds), academic NICU referral centres. PATIENTS Newborn infants with CPAP were screened (n=73), and those with stable spontaneous breathing, low oxygen requirement, postmenstrual age (PMA) over 28 weeks and no comorbidities were eligible. In total, 50 infants were included (median PMA 33 completed weeks). INTERVENTIONS Leakage was measured for both prongs and nasal mask, before and after leak-corrective manoeuvres. Interface application was performed in a randomised order by a nurse, blinded to the measured leakage. MAIN OUTCOME MEASURES 30 s average leakage, measured in litres per minute (LPM). RESULTS Analyses showed a significantly lower leakage (mean difference 0.86 LPM, 95% CI 0.07 to 1.65) with prongs (median 2.01 LPM, IQR 1.00-2.80) than nasal mask (median 2.45 LPM, IQR 0.99-5.11). Leak-corrective manoeuvres reduced leakage significantly for both prongs (median 1.22 LPM, IQR 0.54-1.87) and nasal mask (median 2.35 LPM, IQR 0.76-4.75). CONCLUSIONS Large leakages were common for both interfaces, less with prongs. Simple care manoeuvres reduced leakage for both interfaces. This is the first report of absolute leakage for nasal interfaces and should encourage further studies on leakage during CPAP treatment.
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Affiliation(s)
- Markus Falk
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden .,Department of Anesthesiology, Östersunds sjukhus, Östersund, Sweden
| | - Kolbrun Gunnarsdottir
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Neonatology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Sonja Baldursdottir
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Neonatology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Snorri Donaldsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Neonatology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Baldvin Jonsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Neonatology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Thomas Drevhammar
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Anesthesiology, Östersunds sjukhus, Östersund, Sweden
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Dahl MJ, Veneroni C, Lavizzari A, Bowen S, Emerson H, Rebentisch A, Dawson E, Summers K, Pettet L, Wang Z, Null DM, Yoder BA, Dellacà RL, Albertine KH. Early extubation to noninvasive respiratory support of former preterm lambs improves long-term respiratory outcomes. Am J Physiol Lung Cell Mol Physiol 2021; 321:L248-L262. [PMID: 34009031 DOI: 10.1152/ajplung.00051.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Invasive mechanical ventilation (IMV) and exposure to oxygen-rich gas during early postnatal life are contributing factors for long-term pulmonary morbidities faced by survivors of preterm birth and bronchopulmonary dysplasia. The duration of IMV that leads to long-term pulmonary morbidities is unknown. We compared two durations of IMV (3 h vs. 6 days) during the first 6-7 days of postnatal life in preterm lambs to test the hypothesis that minimizing the duration of IMV will improve long-term respiratory system mechanics and structural outcomes later in life. Moderately preterm (∼85% gestation) lambs were supported by IMV for either 3 h or 6 days before weaning from all respiratory support to become former preterm lambs. Respiratory system mechanics and airway reactivity were assessed monthly from 1 to 6 mo of chronological postnatal age by the forced oscillation technique. Quantitative morphological measurements were made for smooth muscle accumulation around terminal bronchioles and indices of alveolar formation. Minimizing IMV to 3 h led to significantly better (P < 0.05) baseline respiratory system mechanics and less reactivity to methacholine in the first 3 mo of chronological age (2 mo corrected age), significantly less (P < 0.05) accumulation of smooth muscle around peripheral resistance airways (terminal bronchioles), and significantly better (P < 0.05) alveolarization at the end of 5 mo corrected age compared with continuous IMV for 6 days. We conclude that limiting the duration of IMV following preterm birth of fetal lambs leads to better respiratory system mechanics and structural outcomes later in life.
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Affiliation(s)
- Mar Janna Dahl
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Anna Lavizzari
- U.O. di Neonatologia e Terapia Intensiva Neonatale, Department of Clinical Sciences and Community Health, University of Milan Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sydney Bowen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Haleigh Emerson
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Andrew Rebentisch
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Elaine Dawson
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Kyle Summers
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Luke Pettet
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Zhengming Wang
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Donald M Null
- Division of Neonatology, University of California, Davis, California
| | - Bradley A Yoder
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Kurt H Albertine
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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MacDonald KD, Davies M, Lam R, Lund K, Park B, Spindel ER, Tepper RS, McEvoy CT. Chinstraps are needed for neonatal nasal CPAP: Reflections from a non-human primate model. Pediatr Pulmonol 2020; 55:1087-1088. [PMID: 32142204 PMCID: PMC7169434 DOI: 10.1002/ppul.24716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/26/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Kelvin D MacDonald
- Division of Pediatric Pulmonology, Oregon Health & Science University, Portland, Oregon
| | - Michael Davies
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon
| | - Ryan Lam
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Kelli Lund
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Byung Park
- Oregon Health & Science University-Portland State University School of Public Health and Knight Cancer Institute, Portland, Oregon
| | - Eliot R Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon
| | - Robert S Tepper
- Division of Pediatric Pulmonology, HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cindy T McEvoy
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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Ullrich TL, Czernik C, Bührer C, Schmalisch G, Fischer HS. Differential impact of flow and mouth leak on oropharyngeal humidification during high-flow nasal cannula: a neonatal bench study. World J Pediatr 2018. [PMID: 29524125 DOI: 10.1007/s12519-018-0138-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heated humidification is paramount during neonatal high-flow nasal cannula (HFNC) therapy. However, there is little knowledge about the influence of flow rate and mouth leak on oropharyngeal humidification and temperature. METHODS The effect of the Optiflow HFNC on oropharyngeal gas conditioning was investigated at flow rates of 4, 6 and 8 L min-1 with and without mouth leak in a bench model simulating physiological oropharyngeal air conditions during spontaneous breathing. Temperature and absolute humidity (AH) were measured using a digital thermo-hygrosensor. RESULTS Without mouth leak, oropharyngeal temperature and AH increased significantly with increasing flow (P < 0.001). Mouth leak did not affect this increase up to 6 L min-1, but at 8 L min-1, temperature and AH plateaued, and the effect of mouth leak became statistically significant (P < 0.001). CONCLUSIONS Mouth leak during HFNC had a negative impact on oropharyngeal gas conditioning when high flows were applied. However, temperature and AH always remained clinically acceptable.
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Affiliation(s)
- Tim Leon Ullrich
- Department of Neonatology, Charité University Medical Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Czernik
- Department of Neonatology, Charité University Medical Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Gerd Schmalisch
- Department of Neonatology, Charité University Medical Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Hendrik Stefan Fischer
- Department of Neonatology, Charité University Medical Center, Charitéplatz 1, 10117, Berlin, Germany.
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7
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Ullrich TL, Czernik C, Bührer C, Schmalisch G, Fischer HS. Nasal high-frequency oscillatory ventilation impairs heated humidification: A neonatal bench study. Pediatr Pulmonol 2017; 52:1455-1460. [PMID: 28881101 DOI: 10.1002/ppul.23824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/13/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nasal high-frequency oscillatory ventilation (nHFOV) is a novel mode of non-invasive ventilation used in neonates. However, upper airway obstructions due to viscous secretions have been described as specific adverse effects. We hypothesized that high-frequency oscillations reduce air humidity in the oropharynx, resulting in upper airway desiccation. Therefore, we aimed to investigate the effects of nHFOV ventilatory settings on oropharyngeal gas conditions. METHODS NHFOV or nasal continuous positive airway pressure (nCPAP) was applied, along with heated humidification, to a previously established neonatal bench model that simulates oropharyngeal gas conditions during spontaneous breathing through an open mouth. A digital thermo-hygro sensor measured oropharyngeal temperature (T) and humidity at various nHFOV frequencies (7, 10, 13 Hz), amplitudes (10, 20, 30 cmH2 O), and inspiratory-to-expiratory (I:E) ratios (25:75, 33:66, 50:50), and also during nCPAP. RESULTS Relative humidity was always >99%, but nHFOV resulted in lower mean T and absolute humidity (AH) in comparison to nCPAP (P < 0.001). Specifically, decreasing the nHFOV frequency and increasing nHFOV amplitude caused a decline in T and AH (P < 0.001). Mean T and AH were highest during nCPAP (T 34.8 ± 0.6°C, AH 39.3 ± 1.3 g · m-3 ) and lowest during nHFOV at a frequency of 7 Hz and an amplitude of 30 cmH2 O (T 32.4 ± 0.3°C, AH 34.7 ± 0.5 g · m-3 ). Increasing the I:E ratio also reduced T and AH (P = 0.03). CONCLUSION Intensified nHFOV settings with low frequencies, high amplitudes, and high I:E ratios may place infants at an increased risk of upper airway desiccation. Future studies should investigate strategies to optimize heated humidification during nHFOV.
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Affiliation(s)
- Tim L Ullrich
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Christoph Czernik
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Gerd Schmalisch
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Hendrik S Fischer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
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8
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Sivieri EM, Foglia EE, Abbasi S. Carbon dioxide washout during high flow nasal cannula versus nasal CPAP support: An in vitro study. Pediatr Pulmonol 2017; 52:792-798. [PMID: 28165671 DOI: 10.1002/ppul.23664] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/16/2016] [Accepted: 12/15/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare CO2 washout time at different levels of HFNC versus NCPAP in a premature infant lung model with simulated mouth-closed and mouth-open conditions using two sizes of nasal cannula and full- and half-prong HFNC insertion depths. DESIGN/METHODS A piston-cylinder lung simulator, having a fixed volume of 30 ml and a 4.8 ml dead space, simulated spontaneous breathing (6.5 ml tidal volume, 50 br/min, Ti = 0.5 sec). Two Fisher & Paykel™ cannulas (Fisher & Paykel Healthcare Ltd., Auckland, New Zealand) (2.8 and 3.2 mm O.D.) and two Infant-Flow™ (CareFusion, Yorba Linda, CA) NCPAP cannulas (3.4 and 4.1 mm O.D.) were applied to simulated airways having either 3.5 or 4.5 mm I.D. nares. Simulated mouth opening was a 5 mm I.D. side tap below the nasal interface. The lung was primed with 5% CO2 . Washout times were determined at HFNC settings of 3, 4, 5, 6, and 8 L/min and NCPAP at 3, 4, 5, 6, and 8 cm H2 O with simulated open and closed-mouth conditions and full- and half-inserted HFNC prongs. RESULTS Overall combined mean washout times for NCPAP with mouth-closed were significantly longer than HFNC over all five pressure and flow device settings by 16.2% (P < 0.001). CO2 washout times decreased as flow or pressure device settings were increased. There were negligible differences in washout times between NCPAP and HFNC with mouth-open. Mouth-open washout times were significantly less than mouth-closed for all conditions. Overall closed-mouth washout times for HFNC half-prong insertion were longer than for full-prong insertion by 5.3% (P < 0.022). CONCLUSIONS Significantly improved CO2 elimination using HFNC versus NCPAP should be a particularly important consideration in premature infants having very high dead space-to-tidal volume ratio compared to larger infants. Pediatr Pulmonol. 2017;52:792-798. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Emidio M Sivieri
- Section on Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, Pennsylvania.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth E Foglia
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Soraya Abbasi
- Section on Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, Pennsylvania.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Klotz D, Schaefer C, Stavropoulou D, Fuchs H, Schumann S. Leakage in nasal high-frequency oscillatory ventilation improves carbon dioxide clearance-A bench study. Pediatr Pulmonol 2017; 52:367-372. [PMID: 27526104 DOI: 10.1002/ppul.23534] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/13/2016] [Accepted: 07/03/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Nasal high frequency oscillatory ventilation (nHFOV) is a promising mode of non-invasive neonatal respiratory support. To combine the effects of nasal continuous positive airway pressure (nCPAP) and high frequency oscillatory ventilation, an oscillatory pressure waveform is superposed to a nCPAP via a nasal or nasopharyngeal interface. nHFOV has been described to facilitate carbon dioxide (CO2 ) elimination compared to nCPAP. The influence of unintended leakage on CO2 elimination has not been investigated in nHFOV before. We explored the effects of oral leakage on CO2 elimination during nHFOV in a physical model of the neonatal respiratory system. METHODS A neonatal ventilator was connected to an airway- and lung model using binasal prongs as interface. The model comprised a continuous CO2 influx. Alveolar CO2 partial pressure was continuously measured. Gas flow rates and pressures were measured simultaneously at the prongs, pharynx, lung, and at the leakage. Effects of combined nasopharyngeal leakage (0, 5, or 10 L/min) on CO2 elimination, gas flow rate and pressure were determined at various ventilation frequencies (6, 8, 10, and 12 Hz) and amplitudes (10%, 20%, and 30% of maximum ventilator performance) at a mean airway pressure of 10 cmH2 O. RESULTS nHFOV with moderate leakage was more effective in CO2 elimination than without leakage (P < 0.001) for all tested amplitudes and frequencies. Maximum leakage resulted in highly variable, partly ineffective CO2 elimination. CONCLUSIONS A moderate oral leakage rather improves than impairs gas exchange during non-invasive ventilatory support with nHFOV. Pediatr Pulmonol. 2017;52:367-372. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Daniel Klotz
- Department of Neonatology, Center for Pediatrics, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Schaefer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Freiburg, Germany
| | - Dimitra Stavropoulou
- Department of Neonatology, Center for Pediatrics, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans Fuchs
- Department of Neonatology, Center for Pediatrics, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Schumann
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Freiburg, Germany
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10
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Influence of mouth opening on oropharyngeal humidification and temperature in a bench model of neonatal continuous positive airway pressure. Med Eng Phys 2016; 40:87-94. [PMID: 28043780 DOI: 10.1016/j.medengphy.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/07/2016] [Accepted: 12/20/2016] [Indexed: 01/02/2023]
Abstract
Clinical studies show that non-invasive respiratory support by continuous positive airway pressure (CPAP) affects gas conditioning in the upper airways, especially in the presence of mouth leaks. Using a new bench model of neonatal CPAP, we investigated the influence of mouth opening on oropharyngeal temperature and humidity. The model features the insertion of a heated humidifier between an active model lung and an oropharyngeal head model to simulate the recurrent expiration of heated, humidified air. During unsupported breathing, physiological temperature and humidity were attained inside the model oropharynx, and mouth opening had no significant effect on oropharyngeal temperature and humidity. During binasal CPAP, the impact of mouth opening was investigated using three different scenarios: no conditioning in the CPAP circuit, heating only, and heated humidification. Mouth opening had a strong negative impact on oropharyngeal humidification in all tested scenarios, but heated humidification in the CPAP circuit maintained clinically acceptable humidity levels regardless of closed or open mouths. The model can be used to test new equipment for use with CPAP, and to investigate the effects of other methods of non-invasive respiratory support on gas conditioning in the presence of leaks.
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11
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Grassi A, Cecchi F, Sgherri G, Guzzetta A, Gagliardi L, Laschi C. Sensorized pacifier to evaluate non-nutritive sucking in newborns. Med Eng Phys 2016; 38:398-402. [DOI: 10.1016/j.medengphy.2015.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/09/2015] [Accepted: 12/31/2015] [Indexed: 11/30/2022]
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12
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Nasal high-frequency oscillation ventilation in neonates: a survey in five European countries. Eur J Pediatr 2015; 174:465-71. [PMID: 25227281 DOI: 10.1007/s00431-014-2419-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Nasal high-frequency oscillation ventilation (nHFOV) is a non-invasive ventilation mode that applies an oscillatory pressure waveform to the airways using a nasal interface. nHFOV has been shown to facilitate carbon dioxide expiration, but little is known about its use in neonates. In a questionnaire-based survey, we assessed nHFOV use in neonatal intensive care units (NICUs) in Austria, Switzerland, Germany, the Netherlands, and Sweden. Questions included indications for nHFOV, equipment used, ventilator settings, and observed side effects. Of the clinical directors of 186 NICUs contacted, 172 (92 %) participated. Among those responding, 30/172 (17 %) used nHFOV, most frequently in premature infants <1500 g (27/30) for the indication nasal continuous positive airway pressure (nCPAP) failure (27/30). Binasal prongs (22/30) were the most common interfaces. The median (range) mean airway pressure when starting nHFOV was 8 (6-12) cm H2O, and the maximum mean airway pressure was 10 (7-18) cm H2O. The nHFOV frequency was 10 (6-13) Hz. Abdominal distension (11/30), upper airway obstruction due to secretions (8/30), and highly viscous secretions (7/30) were the most common nHFOV side effects. CONCLUSION In a number of European NICUs, clinicians use nHFOV. The present survey identified differences in nHFOV equipment, indications, and settings. Controlled clinical trials are needed to investigate the efficacy and side effects of nHFOV in neonates.
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