Documente Academic
Documente Profesional
Documente Cultură
20 March, 2018
Vladimiras Chijenas, MD
Consultant neonatologist,
Vilnius Maternity Hospital,
Lithuania
1973 Jens Camper et al. Caliumi-Pellegrini
G., et al.
CPAP by the Nasal Route
Arch Dis Child 1974;
49: 228–30.
Fleming, Fanaroff,
Twin nasal cannula
Klaus, et al. A Device for administration of
continuous positive
for Administr ation of
airway pressure to
CPAP by the Nasal
newborn infants
Route
Pediatrics 1973; 52:131
In 1970-1980 some centers stopped using CPAP
after the development of infant ventilators.
VOLUME/BAROTRAUMA (↑PPV-PIP/↑VT)
ATELECTOTRAUMA(OPENING AND CLOSING LUNG UNITS)
RHEOTRAUMA
ENDOTRAUMA
BIOTRAUMA
4
Respiratory rate Minute ventilation
Compliance
Work of breathing
RDS,
AOP - obstructive/mixed apnea of
prematurity,
Weaning from MV, ensuring successful
extubation,
DR stabilisation,
Atelectasis, tracheomalacia, others types of
upper airway obstructions.
Limitations of NRS:
o Ventilatory failure,
o Cardiovascular instability,
o Upper airways abnormalities (choanal
atresia, tracheo-esophageal fistula,
diaphragmatic hernia),
o Unrelenting apneas.
Sankaran K. Neonatal CPAP ventilation, PERINATOLOGY, Vol.12, No.4, 2012
INTERFACES OF NON INVASIVE/NASAL
RESPIRATORY SUPPORT ( NRS)
1
Constant flow systems are either
ventilator derived or use the classic
Zeitachse
underwater bubble CPAP system
Initial stabilization CPAP/PEEP
Strong evidence
Unrelenting apnea:
pH<7.25 PaCO2>60 – 65 mmHg FiO2>60
(Sankaran K. Neonatal CPAP ventilation, PERINATOLOGY, Vol.12, No.4,
2012)
CPAP failed:
18
BiPAP/NIPPV
The major differences of BiPaP compared with NIPPV modes are:
the limited ability to deliver PIP (~10-12 cm H2O),
lower delta pressures (PIP-PEEP: ~3-4 cmH2O) and
use of longer inspiratory times (~ 0.5 to 2 sec.).
NIPPV mode usually provides shorter inspiratory time (0.3-0.5 sec), but
higher (16-25 cm H2O) peak inspiratory pressure.
NIPPV (expected advantages)
Flow adjusted trigger Flow sensors interposed between the Y piece and the 1.Difficult to analyze the flow signals because
nasal cannula and connected to a time-cycled, of the leaks, increase of the dead volume,
pressure-limited neonatal ventilator (Moretti device). 2.Weight of the flow-sensor – risk of nasal
damage
Pressure-adjusted trigger Pressure sensor detects the pressure differences in 1.Difficult to analyze the signals because of the
the reservoir of the generator (connected to the leaks
patient’s airways) while inhaling and exhaling
© Modern Concepts of Noninvasive Respiratory Support in Neonatology, Vladimiras Chijenas et al., Deutscher Wissenschafts-
Verlag (DWV), 2015.
SNIPPV vs. NIPPV and CPAP
SUSTAINED
INFLATION
NIPPV/
HFNC NCPAP
SNIPPV
HFNOV