The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

NASAL INTERMITTENT MANDATORY VENTILATION (NIMV) REDUCES THE NEED FOR INTUBATION IN IMPENDING RESPIRATORY FAILURE INFANTS

Mei-Ju Shih MSN RT RN, H.J. Hsiao RT RN, M.J. Young RT RN Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.

Introduction: Nasal CPAP (NCPAP) has shown that it can reduce the need for intubation and mechanical ventilation in mild to moderate respiratory distressed infants. However, there are still some infants who would fail this trial and need to be intubated and mechanically ventilated. In this study, we proposed an NIMV treatment for the impending respiratory failure infants who fail the trial of O2 therapy or NCPAP in our NICU. The incidence of intubation and the gas exchanges before and after application of NIMV were evaluated.

Method: We reviewed 43 infants (BBW 1467.0 ± 580.9 gm, GA 30.4 ± 3.4 wks, BW on NIMV 1633.2 ± 706.5 gm) who have been placed with a NIMV due to respiratory failure, frequently or severe apnea, or respiratory distress from Feb. 1995 to Dec. 1997 in our NICU. All the subjects received NIMV via a nasal prong (Hudson, CA. USA) and a neonatal ventilator (Infant Star or VIP Bird). The initial settings of NIMV were: flow, 6-15 lpm; PEEP, 5 cmH2O; PIP, 10-15 cmH2O; IMV frequency 6-20 BPM; inspiratory time, 0.5-0.6 sec. FiO2 were titrated to keep PaO2 between 55 and 70 mmHg. PIP were increased to 25 cmH2O by 1-2 cmH2O increments. IMV frequencies were increased to 25 BPM by 2-4 BPM increments. The patient's characteristics, incidence of intubation, associated complications, and gas exchanges before and after NIMV were collected from chart review.

Result: 72.09% (N=31) patients were successfully ventilated and weaned from NIMV without intubation and invasive mechanical ventilation. The PaO2 were increased and the PaCO2 were decreased significantly after the treatment of NIMV. Only one patient (2.32%) developed pneumothorax and 6 patients (13.95%) developed abdominal distension during NIMV.

Gas exchanges before and after NIMV (N=43)

Before NIMV After NIMV Result

PaO2 (mmHg) 61.17 ± 16.29 82.49 ± 28.83 P < 0.001

PaCO2(mmHg) 52.20 ± 14.09 45.46 ± 10.05 P < 0.001

PaO2/PAO2 0.44 ± 0.24 0.50 ± 0.23 P < 0.001

PaO2/FiO2 205.59 ± 86.81 263.02 ± 109.92 P < 0.001

Conclusion: The high successful rate of NIMV in our study suggests that it may be an effective and safe method of ventilatory support for infants who suffer from respiratory distress and fail the treatment of NCPAP or O2 therapy. It may reduce the need for intubation and improve the ventilation as well as oxygenation in these patients.

The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.

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