2004 OPEN FORUM Abstracts
NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) FOR THE POST-EXTUBATION TREATMENT OF PREMATURE INFANTS
Michael Tracy RRT-NPS,
Tim Myers BS, RRT-NPS, Robert Chatburn RRT, FAARC,
Michele Walsh MD. Rainbow Babies
& Children’s Hospital/Case Univ., Cleveland, OH
INTRODUCTION: Continuous positive airway pressure (CPAP) is the current standard for augmenting spontaneous respiration in the neonatal population. Non Invasive Positive Pressure Ventilation (NIPPV) is widely used in pediatric and adult patients to augment and promote spontaneous respiration. NIPPV has been used sporadically to augment spontaneous respiration in neonates. The Cochrane Review (Issue 4, 2003) completed a meta-analysis comparing CPAP and NIPPV for preventing extubation failure, and concluded that NIPPV was more effective than CPAP. The purpose of this study is to retrospectively review the effectiveness of NIPPV in preventing extubation failure in our tertiary NICU.
METHODS: Infants in our NICU that received mechanical ventilation, failed extubation one or more times or were at high-risk for extubation failure who were placed on NIPPV (settings determined at the discretion of the attending physician) were analyzed in this retrospective study from November 2002 to June 2004.
RESULTS: A total of thirteen patients were treated with NIPPV. Eight were supported using nasal prongs, four using nasal cannula and one using nasopharyngeal prongs. Average gestational age 26 1/7 weeks (range 23 - 34 5/7). Birth weight average 952 gms (range 503 – 2915 gms). Days on NIPPV average 9.3 (range 3-24). ∆ P averaged 15.5 cmH2O(range 10-32 cm H2O). Mean airway pressure (Paw) averaged 5.9 cm H2O (range 5 – 8 cm H2O ) prior to NIPPV and 8.0 cm H2O on NIPPV (range 6-16 cm H2O). Ten patients remained off mechanical ventilation (8 weaned to NCPAP, 1 to an oxygen hood and 1 to a nasal cannula). Five patients had their NIPPV weaned while 5 patients had NIPPV at a constant level of support that was discontinued when the pathology was deemed by the attending physician to be resolved. pH & PCO2 averaged 7.36 & 51torr (range: 7.29-7.42 and 37-71 torr) before initiating NIPPV and 7.36 & 52 torr (range 7.29 – 7.40 & 42 – 71 torr) while on NIPPV. Two patients had support withdrawn and expired (1 HSV pneumonia, 1 non-viable necrotizing pneumonia), one was reintubated.
CONCLUSIONS: In the studies reviewed by the Cochrane Group, mean airway pressures were not measured. In our cohort of patients, the average mean airway pressure was 2.1 cm H2O higher on NIPPV than on CPAP or mechanical ventilation. Increased mean airway pressure may account for the high degree of success NIPPV. There was no apparent difference in outcomes from weaning NIPPV support vs. discontinuation of NIPPV upon resolution of the underlying pathophysiology. All patient interface devices, when used correctly, were equally effective in applying NIPPV in this small cohort. pH and CO2 were similar before and after NIPPV. NIPPV was effective in our NICU to prevent extubation failure.