The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

NONINVASIVE VENTILATION IN NEONATES USING THE RAM CANNULA.

Lisa Pappas1, Kevin Crezee2, Greg Moses3, Bradley Yoder4, Rebecca Ungerman1, Whitney Crofts1; 1Respiratory Care, University of Utah Hospital, Salt Lake City, UT; 2Respiratory Care, Primary Children’s Medical Center, Salt Lake City, UT; 3Respiratory Care, Dixie Regional Medical Center, St. George, UT; 4Department of Pediatrics, University of Utah Hospital, Salt Lake City, UT

Background: Noninvasive ventilatory support is commonly needed in neonates with respiratory distress. Both noninvasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP) are common forms of noninvasive ventilation (NIV) used in the NICU. The patient interface has a major impact on success and comfort during NIV. The most commonly used interfaces are nasal prongs and masks. The Ram Cannula is a new noninvasive prong interface introduced in 2011. Design: Anonymous retrospective chart review analysis from November 2011-May 2012. Methods: Patients were managed on the Ram Cannula for increasing respiratory distress or at time of extubation. The Ram Cannula was used with bubble or ventilator based CPAP. A neonatal ventilator was used for NIPPV. Results reported as median and ranges. Analysis by chi-square, Fisher’s Exact and Mann Whitney U. Results: There were 56 infants, 29 males and 27 females. Gestation from 31 (23-39) weeks; weight from 1850 (410 – 3716) grams; NIV start age range 2.5 (1-83) days. 42 infants were treated with NCPAP with pressure range from 7 (4-9) cmH2O. 14 infants were treated with NIPPV with a PIP of 17 (9-22) cmH2O. Median set flow for 44 patients was 10 (5-13) lpm. 47 (84%) patients remained on the RAM cannula during NIV course up to 72 hrs. 9 (16%) were change to alternative support mode; 7 (13%) required intubation. Intubation reasons included respiratory failure (4), surfactant (1), surgery (1), and apnea (1). Conclusions: In our experience using the Ram Cannula we found that the RAM was an effective interface in providing NIV support to neonatal patients with an 84% success rate. No statistically significant difference was noted for the measured variables between patients that failed or were successful. The patients tolerated the RAM cannula during NIV and minimal skin breakdown was noted. More studies are needed. Sponsored Research - None Measured Variables