Synchronized Nasal Intermittent Positive Pressure Ventilation Research Articles

A clinical study evaluating the combination of LISA and SNIPPV for the treatment of respiratory distress syndrome in preterm infants

To compare the therapeutic effect of less invasive surfactant administration (LISA) followed by synchronized nasal intermittent positive pressure ventilation (SNIPPV) and traditional intubate-Surfactant-Extubate (InSurE) strategy for the treatment of neonatal respiratory distress syndrome (NRDS). A single-center, non-randomized and single- blinded study Tertiary neonatal intensive care unit 89 infants enrolled were preterm with gestational age < 366/7 weeks and clinically diagnosed with neonatal RDS (NRDS) Interventions: 32 infants were assigned to the LISA + SNIPPV group and 57 infants to the InSurE + nCPAP group. No statistically significant differences were noted in the baseline characteristics of the enrolled infants. A lower proportion of infants developed BPD in the LISA + SNIPPV group compared to the InSurE + CPAP group [10 (31.25%) vs. 21 (36.84%), P > 0.05]; however, there was no statistically significant difference. The number needed to treat (NNT) with LISA + SNIPPV to prevent BPD development is 18. The mortality rate was not significant between our study arms [1 (3.13%) vs 2 (3.51%), P > 0.05]. There were no statistically significant differences in the durations (days) of MV [(12.18 ± 13.89) vs. (11.35 ± 11.61), P > 0.05], oxygen therapy [(35.03 ± 19.13) vs. (39.75 ± 17.91), P > 0.05] and re-intubation rates [(0.19 ± 0.40) vs. (0.21 ± 0.45), P > 0.05] between the two study groups. In terms of complications, the incidence of patent ductus arteriosus (PDA) [24 (75.00%) vs. 27 (47.37%), P < 0.05] was higher and a lower rate of disturbed liver function [1 (3.23%) vs. 19 (33.33%), P < 0.05] were observed in the LISA + SNIPPV group. Acid–base imbalances were reportedly significantly higher in the InSurE group (P < 0.05). No significant differences in other complications were noted. In the interventional group, FiO2 requirements were significantly lower up until the 3rd week of treatment [FiO2 at day 0, (30.75 ± 4.78) vs. (34.66 ± 9.83), P < 0.05; FiO2 at day 21, (25.32 ± 3.74) vs. (29.11 ± 8.17), P < 0.05], as was RSS on days 2 [(0.77 ± 0.38) vs. (1.94 ± 0.75), P < 0.05] and 3 [(0.66 ± 0.33) vs. (1.89 ± 0.82), P < 0.05] after treatment. Additionally, infants in the standard group had a significantly prolonged hospital stay (days) [(45.97 ± 16.93) vs. (54.40 ± 16.26), P < 0.05]. The combination of LISA and SNIPPV for NRDS can potentially lower the rate of BPD, FiO2 demand and shorten the length of hospitalization.

Synchronized Nasal Intermittent Positive Pressure Ventilation versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants after Congenital Heart Surgery.

This study aimed to evaluate the application of synchronized nasal intermittent positive pressure ventilation (SNIPPV) in the respiratory weaning of infants after congenital heart surgery. We retrospectively analyzed the clinical data of 63 infants who were extubated from mechanical ventilation after congenital heart surgery between January 2020 and September 2020. The data, including demographics, anatomic diagnosis, radiology and laboratory test results, and perioperative variables were recorded. The extubation failure rate within 48 h after extubation was significantly lower in the SNIPPV group than in the nasal continuous positive airway pressure (NCPAP) group. The PaO2 level and PaO2/FiO2 ratio within 48 h after extubation were higher in the SNIPPV group than in the NCPAP group (P < .05). Meanwhile, the PaCO2 level within 48 h was significantly lower in the SNIPPV group (P < .05). Compared with the NCPAP group, the median duration of postoperative noninvasive support and the duration from extubation to hospital discharge were shorter in the SNIPPV group; the total hospital cost was lower in the SNIPPV group. No significant differences were observed between the two groups concerning VAP, pneumothorax, feeding intolerance, sepsis, mortality, and other complications (P > .05). SNIPPV was shown to be superior to NCPAP in avoiding reintubation after congenital heart surgery in infants and significantly improved oxygenation and reduced PaCO2 retention after extubation. Further studies are needed to confirm the efficacy and safety of SNIPPV as a routine weaning strategy.

Efficacy of pulmonary surfactant combined with caffeine citrate on neonatal respiratory distress syndrome treated with synchronized nasal intermittent positive pressure ventilation

Objective To investigate the clinical effects of pulmonary surfactant(PS) combined with caffeine citrate on neonatal respiratory distress syndrome(NRDS) treated with synchronized nasal intermittent positive pressure ventilation(SNIPPV). Methods We collected and analyzed 99 neonates who were diagnosed with NRDS and required SNIPPV treatment from January 2016 to June 2019 in NICU of Shengjing Hospital of China Medical University.According to the different treatment, they were divided into PS+ citrate caffeine combination group and control group.The control group(53 neonates)was treated by PS alone.The combination group(46 neonates)was treated with PS combined with caffeine citrate.The indexes of ventilator time, the time of using oxygen, length of hospital stay and complications were compared between the two groups. Results The indexes of ventilator time, the time of using oxygen and length of hospital stay of combination group were significantly shorter than those of the control group.The differences were statistically significant(P 0.05). Conclusion PS combined with caffeine citrate in the treatment of NRDS with SNIPPV could effectively improve the pulmonary function of infants.It could improve the neonatal survival rate and reduce complications.It is worth to be recommended. Key words: Neonatal respiratory distress syndrome; Synchronized nasal intermittent positive pressure ventilation; Pulmonary surfactant; Caffeine citrate

Predictors of early synchronized non-invasive ventilation failure for infants < 32 weeks of gestational age with respiratory distress syndrome.

IntroductionThe current trend in management of preterm neonates with respiratory distress syndrome is to attempt noninvasive ventilation (NIV) to avoid endotracheal intubation. However, failure of noninvasive ventilation may lead to increased morbidity and mortality. There is a scarcity of studies establishing predictors for the usefulness of NIV in this age group. Our aim here was to determine the predictors of NIV in preterm infants with respiratory distress syndrome (RDS) treated with synchronized nasal intermittent positive pressure ventilation (SNIPPV) for initial respiratory support.Material and methodsWe conducted a follow-up study on 85 infants < 32 weeks of gestational age, and < 1500 g with RDS who received early SNIPPV. Perinatal history, physical characteristics, ventilatory settings, and arterial blood gas analysis results were collected. We recorded the failure rate and potential predictive factors of this failure.ResultsThere were 12 (14.1%) patients who had SNIPPV failure. The SNIPPV failure group had multiple significantly different characteristics compared to the successful SNIPPV group including gestation age, birth weight, grading of disease, severity of respiratory distress, antenatal steroid use and various ventilatory settings. Further multivariate analysis revealed only 3 predictors in our patients: grade of RDS (OR = 4.48, p = 0.008), antenatal steroid use (OR = 1.09, p = 0.01) and mean airway pressure (OR = 1.98, p = 0.0001).ConclusionsFailure of early NIV occurred in a small subset of our patients. Predictors of noninvasive ventilation failure may be a useful guide for decisions regarding intubation.

Surfactant replacement therapy in combination with different non-invasive ventilation techniques in spontaneously-breathing, surfactant-depleted adult rabbits.

Nasal intermittent positive pressure ventilation (NIPPV) holds great potential as a primary ventilation support method for Respiratory Distress Syndrome (RDS). The use of NIPPV may also be of great value combined with minimally invasive surfactant delivery. Our aim was to implement an in vivo model of RDS, which can be managed with different non-invasive ventilation (NIV) strategies, including non-synchronized NIPPV, synchronized NIPPV (SNIPPV), and nasal continuous positive airway pressure (NCPAP). Forty-two surfactant-depleted adult rabbits were allocated in six different groups: three groups of animals were treated with only NIV for three hours (NIPPV, SNIPPV, and NCPAP groups), while three other groups were treated with surfactant (SF) followed by NIV (NIPPV+SF, SNIPPV+SF, and NCPAP+SF groups). Arterial gas exchange, ventilation indices, and dynamic compliance were assessed. Post-mortem the lungs were sampled for histological evaluation. Surfactant depletion was successfully achieved by repeated broncho-alveolar lavages (BALs). After BALs, all animals developed a moderate respiratory distress, which could not be reverted by merely applying NIV. Conversely, surfactant administration followed by NIV induced a rapid improvement of arterial oxygenation in all surfactant-treated groups. Breath synchronization was associated with a significantly better response in terms of gas exchange and dynamic compliance compared to non-synchronized NIPPV, showing also the lowest injury scores after histological assessment. The proposed in vivo model of surfactant deficiency was successfully managed with NCPAP, NIPPV, or SNIPPV; this model resembles a moderate respiratory distress and it is suitable for the preclinical testing of less invasive surfactant administration techniques.

Analysis of the effectiveness of synchronized nasal intermittent positive pressure ventilation for neonatal respiratory failure

Objective To investigate the clinical effect of synchronized nasal intermittent positive pressure ventilation (SNIPPV) in the treatment of neonatal respiratory failure. Methods The clinical data of 52 neonates with respiratory failure treated in our hospital from January 2016 to January 2018 were retrospectively analyzed.According to the different treatment methods, they were divided into observation group and control group, 26 cases in each group.The children in the observation group were treated with SNIPPV, while those in the control group were treated with synchronized intermittent positive pressure ventilation (SIPPV). Clinical efficacy, changes of blood gas analysis results before and after treatment, oxygen consumption time and hospital stay, and complications were compared between the two groups. Results The respiratory rate and heart rate of the two groups improved after treatment, but there were no significant differences between the two groups(P>0.05, respectively). The total effective rate of the observation group was 88.5%, while that of the control group was 92.3%, there was no significant difference between the two groups(χ2=0.221, P>0.05). The pH, PaO2, PaCO2 and oxygen saturation levels of 24 h after treatment in two groups were improved (P 0.05, respectively). Compared with the control group, the oxygen consumption time and hospitalization time of the observation group were significantly shorter, and the differences were statistically significant (P<0.05, respectively). And the observation group had fewer complications of ventilator associated pneumonia. Conclusion The effect of SNIPPV in the treatment of neonatal respiratory failure is significant.It could shorten the time of oxygen consumption and hospitalization and reduce the complications.It is worth popularizing SNIPPV mode assisted ventilation. Key words: Synchronized nasal intermittent positive pressure ventilation; Respiratory failure; Newborn; Validity analysis

Comparison of the clinical effects of different ventilation modes combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome

Objective To compare the clinical efficacy and the complications of two ventilation modes in the premature infants with neonatal respiratory distress syndrome(NRDS). Two different noninvasive ventilation methods, synchronized nasal intermittent positive pressure ventilation(SNIPPV) and nasal continuous positive airway pressure(NCPAP) combined with Curosurf were used in the treatment of patients with NRDS. Methods A retrospective study was conducted in 46 infants with NRDS admitted to our hospital during January 2016 to December 2017.The subjects were divided into SNIPPV group(n=24) and NCPAP group(n=22), respectively combined with Curosurf treatment.PaO2, PaCO2, oxygenation index(OI)(PaO2/FiO2), duration of oxygen therapy, noninvasive ventilation time, reintubation cases for the use of pulmonary surfactant, starting time of feeding, length of hospital stay, incidence of abdominal distention, intracranial hemorrhage, air leakage and other complications were compared between the two groups before and after treatment. Results After treatment, the blood gas indexes of PaO2 and OI at 24 h both in the two groups were significantly higher than those before the treatment(P 0.05). The OI at 24 h [(219±23)mmHg, 1 mmHg=0.133 kPa] was significantly higher in SNIPPV group than that in NCPAP group[(199±26)mmHg](P 0.05). Conclusion SNIPPV and NCPAP combined with Curosurf treatment have similar clinical effects in premature infants with NRDS.While SNIPPV can reduce the starting time of feeding, the time of using noninvasive ventilation, duration of oxygen therapy, length of hospital stay in the patients with NRDS, and the clinical effect is more significant. Key words: Respiratory distress syndrome; Premature infants; Curosurf; Synchronized nasal intermittent positive pressure ventilation; Nasal continuous positive airway pressure,

SNIPPV vs NIPPV: does synchronization matter?

BackgroundUse of nasal intermittent positive pressure ventilation (NIPPV) in the neonatal intensive care unit (NICU) has shown promise with better clinical outcomes in premature neonates. It is not known if synchronization makes a significant clinical impact when using this technique.ObjectiveTo compare clinical outcomes of premature infants on synchronized NIPPV (SNIPPV) vs. NIPPV in the NICU.Design/MethodsRetrospective data were obtained (1/04 to 12/09) of infants who received NIPPV anytime in the NICU. SNIPPV (Infant Star with StarSync) was utilized from 2004–06, while NIPPV (Bear Cub) was used from 2007–09. BPD was defined using the NIH consensus definition. Unadjusted associations between potential risk factors and BPD/death were assessed using the chi-square or Wilcoxon Rank Sum test. Adjusted analyses were performed using generalized linear mixed models, taking into account correlation among infants of multiple gestation.ResultsThere was no significant difference in the mean gestational age and birth weight in the 2 groups: SNIPPV (n=172; 27.0w; 1016g), NIPPV (n=238; 27.7w; 1117g). There were no significant differences in maternal demographics, use of antenatal steroids, gender, multiple births, SGA, or Apgar scores in the 2 groups. More infants in the NIPPV group were given resuscitation in the delivery room (SNIPPV vs. NIPPV: 44.2% vs. 63%, p<0.001). Surfactant use (84.4% vs. 70.2%; p<0.001) was significantly higher in the SNIPPV group. There were no differences in the rate of PDA, IVH, PVL, ROP, and NEC in the 2 groups. After adjusting for the significant variables, use of NIPPV vs. SNIPPV (OR 0.74; 95%CI: 0.42, 1.30) was not associated with BPD/death.ConclusionsThese data suggest that use of SNIPPV vs. NIPPV is not significantly associated with a differential impact on clinical outcomes.

A prospective randomizedcontrolled trial of synchronized nasal intermittent positive pressure ventilation intreatment of hyaline membrane disease in premature infants

：Objective To assess theefficacy of synchronized nasal intermittent positive pressure ventilation (SNIPPV) asprimary treatment of hyaline membrane disease (HMD) in premature infants. Methods Aprospective randomized controlled trial was conducted. Preterm infants, who were diagnosedas HMD, admitted to the neonatal intensive care unit of Peking University Third Hospitalfrom March 2008 to March 2009 were recruited in the study group. Non-invasive ventilationwere given to the infants who still breath with difficulty after surfactant therapy.Twenty infants were randomized to SNIPPV group and 22 comparable infants to NCPAP group.Vital signs, blood gas analysis and prevalence of non-invasive ventilation failure andcomplications were compared between the two groups, t test and x~2 test were used forstatistical analysis. Results Infants treated initially with SNIPPV had a higher PaQ_2level [(78. 3±17. 6) vs (62. 5±20.5) mm Hg, P<0.05, and (83. 3±17. 7) vs (69. 6±18.8) mm Hg, P<0. 05] and lower PaCQ_2 level [(42.2±12.2) vs (53.7±11.0) mm Hg,P<0.05, and (41.4±11.2) vs (55.3±10.9) mm Hg, P<0.05] than those treated withNCPAP after 3 and 12 hours' ventilation, respectively. SNIPPV group had a decreasedincidence of hypoxemia and hyperbicarbonatemia than NCPAP group after 3 hours' ventilation(5. 0% vs 36.4%, P<0.05,and 20.0% vs 50.0%, P<0.05),and a decreased incidence ofhyperbicarbonatemia after 12 hours' ventilation(20.0% vs 59.1%, x~2=6.654,P=0.010).Infants treated initially with SNIPPV had lower incidence of non-invasive ventilationfailure than infants treated with NCPAP(15. 0% vs 45. 5%, x~2 =4.456, P=0.033). There wasno significant difference on the prevalence of complications between the two groups.Conclusions SNIPPV as a primary measure applied after surfactant therapy is feasible inventilation of premature infants with HMD and is more effective than NCPAP.

Synchronized Nasal Intermittent Positive-Pressure Ventilation and Neonatal Outcomes

Synchronized nasal intermittent positive-pressure ventilation (SNIPPV) use reduces reintubation rates compared with nasal continuous positive airway pressure (NCPAP). Limited information is available on the outcomes of infants managed with SNIPPV. To compare the outcomes of infants managed with SNIPPV (postextubation or for apnea) to infants not treated with SNIPPV at 2 sites. Clinical retrospective data was used to evaluate the use of SNIPPV in infants <or=1250 g birth weight (BW); and 3 BW subgroups (500-750, 751-1000, and 1001-1250 g, decided a priori). SNIPPV was not assigned randomly. Bronchopulmonary dysplasia (BPD) was defined as treatment with supplemental oxygen at 36 weeks' postmenstrual age. Overall, infants who were treated with SNIPPV had significantly lower mean BW (863 vs 964 g) and gestational age (26.4 vs 27.9 weeks), more frequently received surfactant (85% vs 68%), and had a higher incidence of BPD or death (39% vs 27%) (all P < .01) compared with infants treated with NCPAP. In the subgroup analysis, SNIPPV was associated with lower rates of BPD (43% vs 67%; P = .03) and BPD/death (51% vs 76%; P = .02) in the 500- to 750-g infants, with no significant differences in the other BW groups. Logistic regression analysis, adjusting for significant covariates, revealed infants with 500-700-g BW who received SNIPPV were significantly less likely to have the outcomes of BPD (OR: 0.29 [95% CI: 0.11-0.77]; P = .01), BPD/death (OR: 0.30 [95% CI: 0.11-0.79]; P = .01), neurodevelopmental impairment (NDI) (OR: 0.29 [95% CI: 0.09-0.94]; P = .04), and NDI/death (OR: 0.18 [95% CI: 0.05-0.62]; P = .006). SNIPPV use in infants at greatest risk of BPD or death (500-750 g) was associated with decreased BPD, BPD/death, NDI, and NDI/death when compared with infants managed with NCPAP.

A randomized controlled trial of synchronized nasal intermittent positive pressure ventilation in RDS

Comparison of outcomes of infants with respiratory distress syndrome (RDS), post-surfactant, extubated to synchronized nasal intermittent positive pressure ventilation (SNIPPV) or continued on conventional ventilation (CV). Prospective post-surfactant randomized controlled trial of primary mode SNIPPV compared with CV in infants (born from July 2000 to March 2005) with birth weights (BW) of 600 to 1250 g. Primary mode SNIPPV was defined as its use in the acute phase of RDS, following the administration of the first dose of surfactant. There were no significant differences in the maternal demographics, antenatal steroid use, mode of delivery, BW, gestational age, gender or Apgar at 5 min between infants continued on CV (n=21) and those extubated to primary mode SNIPPV (n=20). Significantly, more babies in the CV group had the primary outcome of bronchopulmonary dysplasia (BPD)/death, compared to the SNIPPV group (52 versus 20%, P=0.03). There was no difference in the incidence of other common neonatal morbidities. There were no differences in the Mental or Psychomotor Developmental Index scores on follow-up between the two groups. Infants of BW 600 to 1250 g with RDS receiving surfactant with early extubation to SNIPPV had a significantly lower incidence of BPD/death. Primary mode SNIPPV is a feasible method of ventilation in small premature infants.

Synchronized nasal intermittent positive pressure ventilation (SNIPPV) decreases work of breathing (WOB) in premature infants with respiratory distress syndrome (RDS) compared to nasal continuous positive airway pressure (NCPAP)

Synchronized nasal intermittent positive pressure ventilation (SNIPPV) is non-invasive respiratory support that delivers ventilator breaths via the nasal prongs. We hypothesized that SNIPPV is more effective than nasal continuous positive airway pressure (NCPAP) in premature neonates due to decreased work of breathing (WOB). Fifteen infants (BW: 1,367 +/- 325 g, GA: 29.5 +/- 2.4 weeks) were studied on (a) NCPAP at 5 cmH(2)O (NCPAP5) and (b) three increasing SNIPPV settings achieved by NCPAP5 with additional delivered peak inspiratory pressures (PIP) of 10, 12, and 14 cmH(2)O. Tidal volumes and transpulmonary pressures were estimated via calibrated respiratory inductance plethysmography (RIP) and esophageal pressures, respectively. Inspiratory (WOB(insp)), resistive (RWOB), and elastic (WOB(E)) components of WOB were calculated using standard methods. Compared to NCPAP5, (a) WOB(insp) and RWOB were significantly lower with SNIPPV12, and were similarly lower with SNIPPV14 and (b) WOB(E) was significantly lower only with SNIPPV14. WOB components did not differ significantly for the three SNIPPV settings. Tidal volume, respiratory rate (RR), minute ventilation, compliance, and phase angle were similar for all four measurements. In conclusion, compared to NCPAP, the addition of ventilator-delivered PIP during SNIPPV decreases WOB in premature infants.

Effect of Introduction of Synchronized Nasal Intermittent Positive-Pressure Ventilation in a Neonatal Intensive Care Unit on Bronchopulmonary Dysplasia and Growth in Preterm Infants

The objective of this study was to evaluate the incidence of bronchopulmonary dysplasia (BPD), nutritional intake, and growth in premature infants receiving synchronized nasal intermittent positive-pressure ventilation (SNIPPV) versus nasal continuous positive airways pressure (NCPAP) after extubation, at an institution with no prior experience with SNIPPV. This was a retrospective case-control study of infants (born May 2000 to December 2003) at < or = 32 weeks gestation. Extubation to SNIPPV was performed in accordance with a standardized protocol. Infants in the control group were extubated to NCPAP, as per standard nursery practice. There were no significant differences in the maternal characteristics, antenatal corticosteroid use, mode of delivery, gestational age, birthweight, male gender, Apgar scores at 1 and 5 minutes, number of surfactant doses, and duration of endotracheal tube PPV between infants in the control group (n = 30) and those extubated to SNIPPV (n = 30). The duration of NCPAP (median [range]: control versus SNIPPV, 601 [24 to 1270] versus 230.5 [36 to 1200] hours; P < 0.001) and supplemental oxygen (mean +/- standard error of the mean: 84.10 +/- 6.43 versus 63.68 +/- 5.34 days; p = 0.02) was significantly lower in the SNIPPV group. The number of infants with BPD was significantly less in the SNIPPV group (73% versus 40%; p < 0.01). There were no differences between the two groups in total days on parenteral nutrition, caloric intake (total, carbohydrate, protein, or fat), or weight gain. Our results show that introduction of SNIPPV in a neonatal intensive care unit resulted in infants having significantly less need for supplemental oxygen and decreased BPD, without affecting their weight gain or the incidence of other short-term morbidities.

Nasal continuous positive airway pressure versus nasal intermittent positive pressure ventilation for preterm neonates: a systematic review and meta‐analysis

To determine whether nasal intermittent positive pressure ventilation (NIPPV) is more effective in preterm infants than nasal continuous positive airway pressure (NCPAP) in reducing the rate of extubation failure following mechanical ventilation, and reducing the frequency of apnoea of prematurity and subsequent need for endotracheal intubation. Randomized trials of NIPPV versus NCPAP were sought and their data extracted and analysed independently by the authors using the methodology of the Cochrane Collaboration. The analysis used relative risk (RR), risk difference (RD) and number needed to treat (NNT) with 95% confidence intervals. The three studies identified, comparing NIPPV with NCPAP in the postextubation period, all used synchronized NIPPV (SNIPPV), which was more effective than NCPAP in preventing failure of extubation [RR 0.21 (0.10, 0.45), RD -0.32 (-0.45, -0.20), NNT 3 (2, 5)]. Two studies compared NIPPV versus NCPAP for the treatment of apnoea of prematurity. Although meta-analysis was not possible one trial showed a reduction in apnoea frequency with NIPPV and the other a trend favouring NIPPV. SNIPPV is an effective method of augmenting the beneficial effects of NCPAP in preterm infants in the postextubation period. Further research is required to delineate the role of NIPPV in the management of apnoea of prematurity.

A Prospective Randomized Controlled Study Comparing Synchronized Nasal Intermittent Positive Pressure Ventilation (SNIPPV) Versus Nasal Continuous Positive Airway Pressure (NCPAP) as a Method of Weaning Infants with Respiratory Distress Syndrome (RDS) from the Ventilator

A Prospective Randomized Controlled Study Comparing Synchronized Nasal Intermittent Positive Pressure Ventilation (SNIPPV) Versus Nasal Continuous Positive Airway Pressure (NCPAP) as a Method of Weaning Infants with Respiratory Distress Syndrome (RDS) from the Ventilator