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 Two patients had support withdrawn and expired (1 HSV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.