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At our institution, after initial stabilization and resuscitation, we use pressure-triggered nIPPV at relatively high rates 60 per minute or higher, maintaining a 1:1 I/E ratio, with variable PIP, according to chest expansibility and blood gases, and PEEP of 6-7. Later we went to CPAP according to the evolution in the following hours. We also used RAM cannulae with the spouts fixed with hydrocolloid tape around the nasal grits.

  • 1 month later...

Sorry to be late to the party. Been busy.

NIPPV is mostly a stealth way to increase distending pressure to levels most people are unwilling to use with CPAP. The fundamental flaw with all the studies comparing CPAP and NIPPV is that the mean airway pressure is substantially higher with NIPPV than with CPAP. When compared at the same mean airway pressure, there is no difference in short-term outcomes. Luise Owen long ago showed that very few NIPPV cycles generate a measurable tidal volume. This appears to be because the glottis is not open unless the baby is breathing in. Theoretically, synchronization should help this, but it is not always available or effective. Sherry Courtney's group showed that when used with the RAM cannula there is virtually no generated TV whether in synchrony or not. The RAM cannula is a terrible interface, it is really NOT appropriate for CPAP or NIPPV, it is really just a high-flow cannula (no expiratory limb, must not be occlusive). NIV NAVA is probably the only form of NIPPV that truly works - study is in progress to show that. Some of my colleagues like to use NIPPV. When I take over, I switch to CPAP at the same mean pressure and the baby never notices - except for less gas in the belly.....

Cheers,
Martin Keszler, Brown University, Providence, RI

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Thank you Professor Keszler!

How high on PEEP would you go? 'cos, sometimes, MAP on NIPPV could be as high as 12 cmH2O, which is usually higher than the pressure people tend to fell confortable setting on the CPAP.

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