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Hi guys! 

What's your first choice of ventilation suport for extreme preterm babys after delivery Room? nCPAP, NIPPV or HFNC?

Most places I know uses nCPAP. But, the last Cochrane Review (2017) about this issue states that NIPPV reduces respiratory failure and need for intubation, without worsening of adverse effects. 

Any thoughts?

The same goes for post extubation treatment..

 

Hi,

thanks to the Cochrane review that you've mentioned we currently use nIPPV as 1st line treatment for RDS, regardless of the GA of the baby and as 1st line in the post-extubation period as well

Thanks

comment_12312

What initial settings do you use for NIPPV for babies less than 1000g?

We tend to start with PIP 20/PEEP6-8, Rate 40, ITime 0.5.

Wean PIP for PCO2 less than 40 to min 16. Then wean the rate if PCO2 is still less than 40.

In case we have the right ventilator - we use synchronized NIPPV with a Grasby detector (cheap and easy to use compared with NAVA)

Peep at least 6 cmH2O, PIP around 16.

 

We always use s-nippv (Graseby Capsule) with PEEP of 6-8(-10) and starting PIP of 15-17 - changing PIP according to development of CO2. 

Tinsp 0,4.

Around 30-32 GA we tend to use nCPAP with Backup s-Nippv. From 32GA we start with nCPAP alone.

 

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