Nasal Biphasic Positive Airway Pressure Research Articles

Ventilator-delivered nasal intermittent positive pressure ventilation versus nasal biphasic positive airway pressure following extubation in infants ≤1250 g birth weight: a randomized trial

Background and objective To determine the effectiveness of ventilator-delivered nasal intermittent positive pressure ventilation and nasal biphasic positive airway pressure (n-BiPAP) after first extubation attempt in infants ≤1250-g birthweight. Methods This randomized controlled study included mechanically ventilated preterm infants of ≤1250-g birthweight who were randomly assigned to ventilator-delivered NIPPV or n-BiPAP at first extubation within 2 weeks of age. The primary outcome (extubation failure within 96 h following extubation) and secondary outcomes were compared. Results Extubation failure occurred in 22 of 74 infants in n-BiPAP group and 34 of 75 infants in NIPPV group (OR 0.51, 95% CI: 0.26–1.002; p = .05). Duration of invasive and noninvasive ventilation were found to be similar between groups. Also, there were no significant differences among groups for intraventricular hemorrhage, medically/surgically treated patent ductus arteriosus, necrotizing enterocolitis, BPD or death. Conclusion Sustained extubation in infants ≤1250-g birthweight and <2 weeks age did not differ between ventilator-delivered NIPPV and n-BiPAP. Trial registration Clinical Trials.gov under identifier NCT02842190.

N-BiPAP vs n-CPAP in term neonate with respiratory distress syndrome

BackgroundNon-invasive respiratory ventilation has greatly improved the evolution of respiratory distress in neonates, especially for preterm infants, but few studies have investigated the use of non-invasive ventilation (NIV) in term infants. It is useful for neonatologists and nurses to identify the optimal ventilation strategy in terms of effectiveness for this group of newborns.The aim of our study was to investigate what type of respiratory support between nasal Continuous Positive Airway Pressure (nCPAP) or nasal Biphasic Positive Airway Pressure (nBiPAP) is more effective in term neonates with RDS. MethodsOur study was a retrospective observational study of 78 full term neonates who were admitted to the NICU at S. Bambino Hospital from December 2015 to December 2016 for respiratory distress at birth. All patients underwent non-invasive ventilation by nCPAP or nBiPAP were included. Oxygen saturations and vital signs were monitored continuously. We evaluated blood gas analysis parameters before treatment and after 1 h of ventilation. ResultsDuring the study period, there were 78 full term newborns admitted in our NICU for neonatal distress who were treated with nCPAP ore nBIPAP ventilation. In nBiPAP patients, we noticed a statistically significant reduction in PaCO2 levels and FiO2 requirement with respect to nCPAP patients, after 1 h of ventilation with a simultaneous significant increase of pH and PaO2 levels. There was no difference in the length of NIV and hospital stay. Among nCPAP patients, two were then intubated and one developed a pneumothorax. ConclusionThe results of our study showed that an early BiPAP ventilation on RDS is the more efficient NIV because it improves CO2 removal and reduces FiO2 requirement in comparison to nCPAP. Future studies can clarify if early BiPAP ventilation on RDS is the more efficient of NIV.

Comparison of two kinds of noninvasive ventilation mode in premature infants with respiratory failure

Objective To investigate the difference of two models of respiratory failure in preterm infants with nasal continuous positive airway pressure(nCPAP) and nasal biphasic positive airway pressure(nBiPAP). Methods Comparative analysis of 81 cases of premature infants with respiratory failure requiring respiratory support was needed.They were applied nCPAP and nBiPAP ventilation mode treatment.The use of breathing machine and total oxygen inhalation time, the number of treatment failures, the PEEP parameters of the ventilator, the total number of recent complications and secondary infections were compared. Results In the nBiPAP treatment group, the average time of noninvasive ventilation was(96.34 ± 31.5)h, the total time of oxygen inhalation was(10.11 ± 9.39)d, 3 cases of treatment failure, the incidence of severe complications was 5.56%(2/36), PEEP(4.08±0.73)cmH2O(1 cmH2O=0.098 kPa). In the nCPAP group, the average time of noninvasive ventilation was(114.14±41.69)h, the total time of oxygen inhalation was(17.53±15.96)d, 15 cases were failed, the incidence of severe complications was 15.56%(7/45), PEEP(5.11±1.01)cmH2O.There were significant differences between the two groups(P 0.05). Conclusion nBiPAP as one of the first choice treatment for premature infants with respiratory failure significantly better than nCPAP, as soon as the proper use can avoid invasive ventilation. Key words: Positive airway pressure; Mechanical ventilation; Preterm infants; Newborn; Respiratory failure

N-BiPAP treatment in infants with respiratory distress syndrome: A population study

BackgroundSince November 1st 2008, our Norwegian neonatal intensive care unit has used nasal biphasic positive airway pressure (n-BiPAP) instead of invasive mechanical ventilation as first-line treatment after nasal continuous positive airway pressure (n-CPAP) failure in infants with respiratory distress syndrome (RDS). AimTo assess utility of a national patient register to compare outcomes of infants in our unit before and after November 1st 2008 as well as to hospitals that did not utilize n-BiPAP during the observation period. Study designA retrospective study, using a national patient register and a difference-in-difference (DID) statistical approach, adjusting for confounders. SubjectsInfants with RDS admitted to hospital 2002–2010. Outcome measuresWe compared our unit before and after November 1st 2008 and to other hospitals with regards to morbidity, mortality, and number of hospital days (NHD). ResultsInfants with RDS in our unit had a significantly lower risk of bronchopulmonary dysplasia (BPD) (odds ratio (OR) 0.59, p<0.05), retinopathy of prematurity (ROP) (OR 0.57, p<0.05), and intraventricular hemorrhage (IVH) (OR 0.37, p<0.001); as well as the combined outcome of periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), ROP, IVH, and/or BPD (OR 0.53, p<0.05) after November 1st 2008 and compared to other hospitals. PVL, NEC, and mortality did not change. NHD was reduced by 8. ConclusionIncreasing use of n-BiPAP was associated with reduced morbidity and NHD in infants with RDS. Using a patient register and DID analyses may be a health economic and ethically sound way of generating hypotheses and knowledge about disease and treatment.

Isolated Pneumopericardium in a Preterm Infant on Nasal Biphasic Positive Airway Pressure

Different modalities of non-invasive ventilation (NIV), one of which is nasal biphasic positive airway pressure (nBiPAP), are used both after extubation and as an alternative to intubation in suitable cases. Just as mechanical ventilation (MV), NIV can be complicated by air leak syndromes. Pneumopericardium (PPC), especially if isolated, is the rarest of these conditions. We present a case of isolated PPC in a preterm newborn as a complication of nBiPAP. Int J Clin Pediatr. 2014;3(4):111-113 doi: http://dx.doi.org/10.14740/ijcp173w

Effect of Nasal Continuous and Biphasic Positive Airway Pressure on Lung Volume in Preterm Infants

To monitor regional changes in end-expiratory lung volume (EELV), tidal volumes, and their ventilation distribution during different levels of nasal continuous positive airway pressure (nCPAP) and nasal biphasic positive airway pressure (BiPAP) in stable preterm infants. By using electrical impedance tomography and respiratory inductive plethysmography, we measured changes in EELV and tidal volumes in 22 preterm infants (gestational age 29.7±1.5 weeks) during 3 nCPAP levels (2, 4, and 6 cmH2O) and unsynchronized BiPAP (nCPAP=6 cmH2O; pressure amplitude=3 cmH2O; frequency=50/min; inspiration time=0.5 seconds) at 10-minute intervals. We assessed the distribution of these volumes in ventral and dorsal chest regions by using electrical impedance tomography. EELV increased with increasing nCPAP with no difference between the ventral and dorsal lung regions. Tidal volume also increased, and a decrease in phase angle and respiratory rate was noted by respiratory induction plethysmography. At the regional level, electrical impedance tomography data showed a more dorsally oriented ventilation distribution. BiPAP resulted in a small increase in EELV but without changes in tidal volume or its regional distribution. Increasing nCPAP in the range of 2 to 6 cmH2O results in a homogeneous increase in EELV and an increase in tidal volume in preterm infants with a more physiologic ventilation distribution. Unsynchronized BiPAP does not improve tidal volume compared with nCPAP.

EXTUBATE: A randomised controlled trial of nasal biphasic positive airway pressure vs. nasal continuous positive airway pressure following extubation in infants less than 30 weeks' gestation: study protocol for a randomised controlled trial

BackgroundRespiratory distress syndrome remains a significant problem among premature infants. Mechanical ventilation through an endotracheal tube remains the mainstay of respiratory support but may be associated with lung injury and the development of chronic lung disease of prematurity. Efforts are needed to reduce the duration of mechanical ventilation in favour of less invasive forms of respiratory support and to improve rates of successful extubation.Non-invasive respiratory support has been demonstrated to be less injurious to the premature lung. Standard practice is to use nasal continuous positive airway pressure (n-CPAP) following extubation to support the baby's breathing. Many clinicians also use nasal biphasic positive airway pressure (n-BiPAP) in efforts to improve rates of successful extubation. However, there is currently no evidence that this confers any advantage over conventional nasal continuous positive airway pressure.MethodsWe propose an unblinded multi-centre randomised trial comparing n-CPAP with n-BiPAP in babies born before 30 weeks' gestation and less than two weeks old. Babies with congenital abnormalities and severe intra-ventricular haemorrhage will be excluded. 540 babies admitted to neonatal centres in England will be randomised at the time of first extubation attempt. The primary aim of this study is to compare the rate of extubation failure within 48 hours following the first attempt at extubation. The secondary aims are to compare the effect of n-BiPAP and n-CPAP on the following outcomes:1. Maintenance of successful extubation for 7 days post extubation2. Oxygen requirement at 28 days of age and at 36 weeks' corrected gestational age3. Total days on ventilator, n-CPAP/n-BiPAP4. Number of ventilator days following first extubation attempt5. pH and partial pressure of carbon dioxide in the first post extubation blood gas6. Duration of hospital stay7. Rate of abdominal distension requiring cessation of feeds8. Rate of apnoea and bradycardia9. The age at transfer back to referral centre in daysThe trial will determine whether n-BiPAP is safe and superior to n-CPAP in preventing extubation failure in babies born before 30 weeks' gestation and less than two weeks old.Trial registration numberISRCTN: ISRCTN18921778