Noninvasive ventilation strategies examined in NICU infants

1. Noninvasive ventilator strategies provide an alternative to mechanical ventilation in very low birth weight infants and are being explored as treatment modalities to reduce the incidence of ventilator-induced lung injury.

2. There were no statistical differences found in the duration of required ventilation, failure rates, and selected secondary outcomes between bilevel continuous positive airway pressure (BiPAP) and nasal synchronized intermittent positive pressure ventilation (NSIPPV).

Evidence Rating Level: 1 (Excellent)

Study Rundown: In recent decades, modes of noninvasive ventilation have been explored as a primary alternative therapy to mechanical ventilation in very low birth weight infants with respiratory distress syndrome. These noninvasive ventilation strategies are postulated to decrease rates of ventilator-induced lung injury in infants. This randomized controlled trial compared 2 modes of noninvasive ventilation, BiPAP and NSIPPV, and found no significant differences in duration of required ventilation, failure rates, or selected secondary outcomes. Although these findings may provide reassurance of equal efficacy and safety between BiPAP and NSIPPV, this study is limited by its inability to directly compare these 2 modalities to mechanical ventilation. Nonetheless, this study provides a foundation for further research in noninvasive ventilator support in very low birth weight infants.

Click to read the study, published today in Pediatrics

Relevant Reading: Respiratory Support in Preterm Infants at Birth

Study Author, Dr. Diego Gazzolo, MD PhD, talks to 2 Minute Medicine: Neonatal ICU, C. Arrigo Children’s Hospital, Alessandria, Italy.

“We conducted the first randomized study that compared two different modalities of Non-Invasive Ventilation (NIV) such as synchronized intermittent positive pressure and bi-level CPAP (BiPAP) a non-synchronized two alternate different level of CPAP, in which the newborns can breathe spontaneously. Results showing no differences in terms of duration of ventilation, failure and secondary outcomes suggest that both different NIV strategies are effective and safe when used as first intention respiratory support for RDS treatment of preterm newborns. Of note, NIV can constitute a valid alternative option to mechanical ventilation and its main complication, the so-called ventilator induced lung injury. Further investigations comparing NSIPPV, BiPAP and CPAP will elucidate which among NIV strategies could be safer and effective as first intention respiratory support for RDS treatment in preterm newborns.”

In-Depth (randomized controlled trial): Participants included 124 very low birth weight infants (<1500 g and <32 weeks gestational age) with respiratory distress syndrome from 2 neonatal intensive care units (NICUs) in Italy. Immediately after birth, all enrolled infants received standard care, including suctioning, sustained lung inflation, and nasal continuous positive airway pressure (NCPAP). Neonates ≤26 weeks gestational age also received prophylactic surfactant. All enrolled infants were then randomized to either BiPAP (n = 62) or NSIPPV (n = 62) within 2 hours of birth. Failure rates (persistent or recurrent hypoxia, acidosis and hypercarbia, apnea, necrotizing enterocolitis, bowel perforation, hemodynamic instability) between BiPAP and NSIPPV were statistically not significant (P = 0.80). Additionally, there was no significant difference (P = 0.45) between average hours of required ventilation support (NSIPPV = 89, BiPAP = 87). Secondary outcomes – including pneumothorax, interventricular hemorrhage, periventricular leukomalacia, need for repeated surfactant doses, need for postnatal glucocorticoids, persistent patent ductus arteriosis requiring intervention, retinopathy of prematurity, late onset sepsis, days to regain birth weight, death – were also not found to be statistically significant between BiPAP and NSIPPV groups.

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Image: PD 

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