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Neonatal Non-Invasive Respiratory Support: Synchronised NIPPV, Non-Synchronised NIPPV or Bi-Level CPAP: What Is the Evidence in 2013?
MedLine Citation:
PMID:  23989138     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Nasal continuous positive airway pressure (NCPAP) has proven to be an effective mode of non-invasive respiratory support in preterm infants; however, many infants still require endotracheal ventilation, placing them at an increased risk of morbidities such as bronchopulmonary dysplasia. Several other modes of non-invasive respiratory support beyond NCPAP, including synchronised and non-synchronised nasal intermittent positive pressure ventilation (SNIPPV and nsNIPPV) and bi-level positive airway pressure (BiPAP) are now also available. These techniques require different approaches, and the exact mechanisms by which they act remain unclear. SNIPPV has been shown to reduce the rate of reintubation in comparison to NCPAP when used as post-extubation support, but the evidence for nsNIPPV and BiPAP in this context is less convincing. There is some evidence that NIPPV (whether synchronised or non-synchronised) used as primary respiratory support is beneficial, but the variation in study methodology makes this hard to translate confidently into clinical practice. There is currently no evidence to suggest a reduction in mortality or important morbidities such as bronchopulmonary dysplasia, with NIPPV or BiPAP in comparison to NCPAP, and there is a lack of appropriately designed studies in this area. This review discusses the different approaches and proposed mechanisms of action of SNIPPV, nsNIPPV and BiPAP, the challenges of applying the available evidence for these distinct modalities of non-invasive respiratory support to clinical practice, and possible areas of future research. © 2013 S. Karger AG, Basel.
Authors:
C T Roberts; P G Davis; L S Owen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-28
Journal Detail:
Title:  Neonatology     Volume:  104     ISSN:  1661-7819     ISO Abbreviation:  Neonatology     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-8-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101286577     Medline TA:  Neonatology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  203-209     Citation Subset:  -    
Affiliation:
The Royal Women's Hospital, Parkville, Vic., Australia.
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