99nicu Poll: do you support breathing for preterm infants with nasal IPPV or nasal CPAP?

[Stefan Johansson]

Nasal IPPV is a respiratory support technology that is spreading in NICUs around the world.

Those of you attending Hot topics 2012 or EBNEO 2013 probably heard about a comparative study in which nasal IPPV and regular nasal CPAP was compared in extremely preterm infants.

We would like to check the temperature how nasal IPPV is used "pre-publication" of the results presented at Hot Topics and EBNEO.

[pmaglidt]

The use of the SIPAP non-invasive machine in bi-phasic mode(BIPAP) is a great arrow in the quiver to try before intubating a baby that is in respiratory distress and having apneic spells. As a respiratory therapist I like this technology because it allows at least the baby a chance to get through those periodoc breathing episodes and help maintain stimulation and allow the baby to have a decent minute ventilation. It also can prevent the baby from buying a tube right away.

It has a set rate, pip, peep, I-time and with a upper and lower pressure that has a delta-p effect..

Edited April 13, 2013 by pmaglidt

[drmkumar]

we are using this nasal ippv mode instead of cpap comfortably in treating respiratory distress especially in extremely premature infants. nasal ippv mode is really superior than cpap and helps to avoid invasive ventilation in lot of cases

Nasal IPPV is a respiratory support technology that is spreading in NICUs around the world.

Those of you attending Hot topics 2012 or EBNEO 2013 probably heard about a comparative study in which nasal IPPV and regular nasal CPAP was compared in extremely preterm infants.

We would like to check the temperature how nasal IPPV is used "pre-publication" of the results presented at Hot Topics and EBNEO.

[Dinesh N Patel]

drkumar,

which ventilator you r using fof nasal ippv mode ?

dinesh

[Plyon0962]

we do use non invasive cpap on our infants but we use either the oral ett or we have a mask and nasal prong that is used with our vents. what has helped us with ventilation is the use of bubble cpap and curosuf

[Plyon0962]

avia is the vent that we use

[nashwa]

I s BIBAP used with nasal prong or with nasopharyngeal tube

is this mode present in Benet m v

[drmkumar]

we are using SLE, INFANT STAR, TAKAOKA VENTILATORS

[pmaglidt]

We use the infant flow for NIV CPAP with either the prongs or mask. When it comes to needing a rate and more support the carefusion NIV positive pressure device works great (having cpap and bipap capabilities) to attempt keeping a baby having respiratory distress from getting intubated. At a hospital I worked at we also utilized what they called nasal-pap (NIV) throught the PB840. I feel the SIPAP machine from carefusion is great due to flexibility of starting a baby on BIPAP, if needed and the changing them to CPAP and only using one machine. I have noticed the selective use of surfactant being more moderate over starting a baby on 5cmH2O CPAP and then weanng them off ASAP after there has been the recruitment needed. The surfactant deficiency in premies is an issue though i have seen surfactant replacement therapy being used less and more selectively....

[pmaglidt]

From the initial post about the temperature with nasal IPPV we use it with the invasive mode on the passover humidifier in pre-term infants 37 C but switch to non-invasive for the more term babies at 32 C

[Stefan Johansson]

From the initial post about the temperature with nasal IPPV we use it with the invasive mode on the passover humidifier in pre-term infants 37 C but switch to non-invasive for the more term babies at 32 C

The "temperature" was meant symbolically , we just want to find out how people use nIPPV before publication about the nIPPV trial results.

[nashwa]

how can i use it

[Dinesh N Patel]

I have dragger 8000,Bear 750PSV VENTILATORs, Bubble CPAP Fisher and Pakle, lnfant flow drive Cpap. Somebody can give me the idea that how l can give nasal SIPPV with this set up or I have to buy dedicatd nasal SIPPV ventilator?

Thanks

Dinesh

[nashwa]

iS it used with nasopharyngeal tube and nasopharyngeal prong which better

can i use them "nasopharyngeal tube and nasopharyngeal prong" with CPAP or not

is it necessary to use this mode on ventilator

[mahatma]

Apparently there was a trial published in NEJM which showed no significant difference between preterms (<1000g) who received either CPAP or nIPPV as non-invasive ventilation, primary outcome was death or BPD at 36 weeks gestational age. (Kirpalani et al, "A trial comparing noninvasive ventilation strategies in preterm infants", NEJM Aug ´13)

[Stefan Johansson]

Apparently there was a trial published in NEJM which showed no significant difference between preterms (<1000g) who received either CPAP or nIPPV as non-invasive ventilation, primary outcome was death or BPD at 36 weeks gestational age. (Kirpalani et al, "A trial comparing noninvasive ventilation strategies in preterm infants", NEJM Aug ´13)

Yes, indeed - here's the link!

http://www.nejm.org/doi/full/10.1056/NEJMoa1214533

I copy&paste the abstractt below:

Background

To reduce the risk of bronchopulmonary dysplasia in extremely-low-birth-weight infants, clinicians attempt to minimize the use of endotracheal intubation by the early introduction of less invasive forms of positive airway pressure.

Methods

We randomly assigned 1009 infants with a birth weight of less than 1000 g and a gestational age of less than 30 weeks to one of two forms of noninvasive respiratory support — nasal intermittent positive-pressure ventilation (IPPV) or nasal continuous positive airway pressure (CPAP) — at the time of the first use of noninvasive respiratory support during the first 28 days of life. The primary outcome was death before 36 weeks of postmenstrual age or survival with bronchopulmonary dysplasia.

Results

Of the 497 infants assigned to nasal IPPV for whom adequate data were available, 191 died or survived with bronchopulmonary dysplasia (38.4%), as compared with 180 of 490 infants assigned to nasal CPAP (36.7%) (adjusted odds ratio, 1.09; 95% confidence interval, 0.83 to 1.43; P=0.56). The frequencies of air leaks and necrotizing enterocolitis, the duration of respiratory support, and the time to full feedings did not differ significantly between treatment groups.

Conclusions

Among extremely-low-birth-weight infants, the rate of survival to 36 weeks of postmenstrual age without bronchopulmonary dysplasia did not differ significantly after noninvasive respiratory support with nasal IPPV as compared with nasal CPAP. (Funded by the Canadian Institutes of Health Research; NIPPV ClinicalTrials.gov number, NCT00433212; Controlled-Trials.com number, ISRCTN15233270.)

[Guest mmerocru]

About CPAP machines: dose anybody use medijet vs infant flow sipap? If you have to buy a new CPAPn machine, what is your opinion?