Is SiPAP being used in most NICU's?

We Are using Sipap and we have really good results. Do anyone know a leading article ON sipap and premies? Which settimg of sipap Are you using?

Edited September 9, 200916 yr by JACK

in the litterature it is mentioned that the rate of failure of extubatin is less ( ie rate of rintubation is less) in somebody who already needed reintubation with N-CPAP with the use of SIPAP .

What do you mean by SIPAP (and the difference between N-CPAP) ?

Thanks for any explanation

Nasal CPAP refers to a continuous fixed positive airway pressure level applied by the machine. For example a CPAP of 5 cmH2O, delivers a pressure of 5 cm H2O continuously

In SiPAP, there are two pressure levels set. The lower level and the higher level. The higher pressure is delivered at a rate fixed by the operator. The shift from the lower pressure to the higher pressure level is a 'sigh'. The time for which the higher pressure level is applied is the Ti. For example with the settings of lower pressure level = 5 , higher = 7 , Ti= 1 sec, Rate 10 /min, the baby will get a cpap of 5 cm H2O continuously but with intermittent increase of the pressure level to 7 cm H2o lasting for 1 sec. These increased levels of pressure will occur at a rate of 10 per minute.

I have some doubts: in our unit we use such SiPAP setting, but in literature I always found setting of SiPAP as a nasal SIPPV. DO you know where I can find setting similar to those we use to do?

I found the following online resources

http://nursing.uchc.edu/unit_manuals/respiratory/nicu_respiratory/docs/Infant%20Flow%20SiPAP.pdf

http://www.newbornnetworks.org.uk/staffs/documents/SiPAPtrainingsession.pdf

http://www.summittechnologies.ca/clinical/SiPAP%20-%20Strategy%20Implementation%20Guide2%20-%20L2633.pdf

Thanks Jack for your help.

I didn't find any article on bilevel SiPAP? Do you?

...bilevel SiPAP..

I think SiPAP is nothing but a form of bilevel nasal CPAP.

So I think there will not be a bilevel SiPAP as SiPAP already has two pressure levels in its design.

...find any article..

Here are two journal articles where you may find more information

Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation.

Davis PG, Morley CJ, Owen LS.

Semin Fetal Neonatal Med. 2009 Feb;14(1):14-20. Epub 2008 Oct 4.

LINK

Neonatal nasal intermittent positive pressure ventilation: a survey of practice in England.

Owen LS, Morley CJ, Davis PG.

Arch Dis Child Fetal Neonatal Ed. 2008 Mar;93(2):F148-50. Epub 2007 Sep 17.

LINK

Edited October 2, 200916 yr by JACK

Dear Jack

I agree with you but in many articles I can find setting similar to a nasal-SIPPV rather than a bilevel CPAP (i.e. we use to set a Ti of 1 - 1,5 sec with rate of 15 per minutes; in all the article I found I always find setting as SIPPV.

In the forum about SIPAP there are setting as Bilevel. That's why I am concerned about SIPAP

hi every one..i ll answer ur questions..1-SIPAP theoritically is an open cpap system with the advantage of giving (synchronised or non sync mandatory) 2levels of airway pressures..defenitely one level will be lower than the other..the lower will be identical to endexpiratory P A W pressure..the other will be higher named SIGH..Now what about settings???? answer will differ according to tha advantage u want to give to ur neoborn..and i can give u 2 examples here A)setting u mentioned mimics invasive BIPAP ventilation in adults with relatively more prolonged inspiratory pressure time ...advantage will be REDISTRIBUTION OF INSP TIDAL VOLUME>>an advantage will appear in a spont breather with decreased lung compliance.... another setting strategy will depend on HIGHER insp. press. setting with a more physiological insp. time.(0.3-0.45)...an advantage will appear in preventing intabation from start as a non invasive ventilation strategy or in infants prdicted to experience multiple attacks of apneas... i hope that i answered u correctly..i want to read any comments if any..THANKS>>dr khalil abo ahmad alexandria egypt

hamakoosha:

Interesting!

Will it in "Biphasic Trigger"-mode deliver the higher pressure on every triggered breath?

Did I understand it correctly: In biphasic-mode e.g. 10 breaths/min. with PEEP 5 PIP 8 Ti 1s it will give a "breath" 1 second long (sigh) every sixth second and between it will act as a regular nCPAP (just keep PEEP at 5) ?

During the "breath" (sigh) will it be 8 cmH20 during inspiration and 5cmH2O during expiration?

I checked with a sales person so I will answer my own questions:

yes, yes and yes ;-)

hamakoosha:

Interesting!

Will it in "Biphasic Trigger"-mode deliver the higher pressure on every triggered breath?

Did I understand it correctly: In biphasic-mode e.g. 10 breaths/min. with PEEP 5 PIP 8 Ti 1s it will give a "breath" 1 second long (sigh) every sixth second and between it will act as a regular nCPAP (just keep PEEP at 5) ?

During the "breath" (sigh) will it be 8 cmH20 during inspiration and 5cmH2O during expiration?

SiPap is a new tool for me since I started in the new hospital I moved into. Honestly, my personal view is like: Sipap is great because of the mask that we use, by decreasing the degree of nasal septum injury and edema of the nasal airways. however , I'm not convvinced that the "PIP" has anything to do with it ..not even the rate..it's just the mask..

one time , 2 years ago, I read about a study was done in Rome, Italy usinf something close to Sipap or even cloder to Bipap but synncronized with the baby's breath..I think that would be ideal.

lastly, I found usful in preventing the reintubation more that preventing the intubation for the first time.

Again, my experience is limited, it's been just 6 months since I've used it for the first time.

HI! We are currently using an 840 ventilator with the NEo mode software to give 'snippv' (syncronized intermittant positive pressure ventilation). I do not like it as it auto cycles alot and the flow rates seem too high for the baby. We have the SiPap system but our head neo will not let us use it as he says there's not been enough data to convince him it's a good thing. We Rt's LOVED it. Our babies (when we trialed the machine) weemed to be more comfortable and had decreased WOB eith it. There is now a study out of Italy comparing SiPAP and just CPAP and the SiPaP did better.

Gimpy RT

Are you referring to the Viasys (Carefusion) SiPAP Machine? Is there any other manufacturer producing such machines?