Download PDF
Am J Perinatol 2022; 39(S 01): S63-S67
DOI: 10.1055/s-0042-1758868
Original Article

Different Settings of Nonsynchronized Bilevel Nasal Continuous Positive Airway Pressure and Respiratory Function in Preterm Infants: A Pilot Study

Francesco Cavigioli   *
1   Division of Neonatology, “V.Buzzi” Children's Hospital, ASST FBF-Sacco, Milan, Italy
,
Ilia Bresesti   *
1   Division of Neonatology, “V.Buzzi” Children's Hospital, ASST FBF-Sacco, Milan, Italy
2   Department of Medicine and Surgery, University of Insubria, Varese, Italy
,
Sara Gatto
1   Division of Neonatology, “V.Buzzi” Children's Hospital, ASST FBF-Sacco, Milan, Italy
,
Francesca Castoldi
1   Division of Neonatology, “V.Buzzi” Children's Hospital, ASST FBF-Sacco, Milan, Italy
,
Danilo Gavilanes
3   Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
,
Diego Gazzolo
4   Neonatal Intensive Care Unit, G. D'Annunzio University, Chieti, Italy
,
Massimo Agosti
2   Department of Medicine and Surgery, University of Insubria, Varese, Italy
,
Boris Kramer
3   Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
,
Gianluca Lista
1   Division of Neonatology, “V.Buzzi” Children's Hospital, ASST FBF-Sacco, Milan, Italy
› Author Affiliations Funding This research received no specific grant from any funding agency in public, commercial, or no-profit sectors.
› Further Information
    Permissions and Reprints

Abstract

Objective With this study, we evaluated the short-term effects of different modes and settings of noninvasive respiratory support on gas exchange, breathing parameters, and thoracoabdominal synchrony in preterm infants in the acute phase of moderate respiratory distress syndrome.

Study Design A feasibility crossover trial was conducted in neonates < 32 weeks' gestation on nasal continuous positive airway pressure (n-CPAP) or bilevel n-CPAP. Infants were delivered the following settings in consecutive order for 10 minutes each: • n-CPAP (5 cm H2O) • bilevel n-CPAP 1 (Pres low = 5 cm H2O, Pres high = 7 cm H2O, T-high = 1 second, rate = 30/min) • n-CPAP (5 cm H2O) • bilevel n-CPAP 2 (Pres low = 5 cm H2O, Pres high = 7 cm H2O, T-high = 2 second, rate = 15/min) • n-CPAP (5 cm H2O). During each phase, physiologic parameters were recorded; the thoracoabdominal synchrony expressed by the phase angle (Φ) and other respiratory patterns were monitored by noncalibrated respiratory inductance plethysmography.

Results Fourteen preterm infants were analyzed. The mean CPAP level was significantly lower in the n-CPAP period compared with bilevel n-CPAP 1 and 2 (p = 0.03). Higher values were achieved with bilevel n-CPAP 2 (6.2 ± 0.6 vs. 5.7 ± 0.5 cm H2O, respectively; p < 0.05). No statistical difference in the Φ was detected, nor between the three settings.

Conclusion Our study did not show any superiority of bilevel n-CPAP over n-CPAP. However, nonsynchronized bilevel n-CPAP might be helpful when additional pressure is needed.

Key Points

  • There is currently a high degree of uncertainty about the superiority of one modality and setting of noninvasive respiratory over another.

  • Our study confirmed that non-synchronized bilevel n-CPAP might be helpful when additional pressure is needed for recruitment.

  • A T-high of 1 second could possibly be better tolerated in this population, but further research is needed.

Keywords

bilevel CPAP - preterm infants - respiratory function monitoring

Authors' Contributions

F.C.: drafted the initial manuscript; recorded and analyzed the data; reviewed and revised the manuscript. I.B.: wrote the manuscript; critically revised the data analysis. S.G.: reviewed and revised the manuscript. D.G.: review and revised the manuscript. D.G.: review and revised the manuscript. B.K.: review and revised the manuscript. F.C.: reviewed and revised the manuscript. M.A.: reviewed and revised the manuscript. G.L. conceptualized and designed the study and revised the final manuscript.


All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


* Equally contributing authors.




Publication History

Article published online:
05 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Bancalari E, Claure N, Sosenko IR. Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol 2003; 8 (01) 63-71
    CrossrefPubMedGoogle Scholar
  • 2 Bresesti I, Zivanovic S, Ives KN, Lista G, Roehr CC. National surveys of UK and Italian neonatal units highlighted significant differences in the use of non-invasive respiratory support. Acta Paediatr 2019; 108 (05) 865-869
    CrossrefPubMedGoogle Scholar
  • 3 Migliori C, Motta M, Angeli A, Chirico G. Nasal bilevel vs. continuous positive airway pressure in preterm infants. Pediatr Pulmonol 2005; 40 (05) 426-430
    CrossrefPubMedGoogle Scholar
  • 4 Lin CH, Wang ST, Lin YJ, Yeh TF. Efficacy of nasal intermittent positive pressure ventilation in treating apnea of prematurity. Pediatr Pulmonol 1998; 26 (05) 349-353
    CrossrefPubMedGoogle Scholar
  • 5 Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics 2001; 107 (04) 638-641
    Google Scholar
  • 6 Roberts CT, Davis PG, Owen LS. Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013?. Neonatology 2013; 104 (03) 203-209
    CrossrefPubMedGoogle Scholar
  • 7 Solevåg AL, Cheung PY, Schmölzer GM. Bi-Level Noninvasive Ventilation in Neonatal Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Neonatology. Basel, Switzerland: S. Karger AG; 2021: 1-10
    Google Scholar
  • 8 Sivieri EM, Wolfson MR, Abbasi S. Pulmonary mechanics measurements by respiratory inductive plethysmography and esophageal manometry: methodology for infants on non-invasive respiratory support. J Neonatal Perinatal Med 2019; 12 (02) 149-159
    CrossrefPubMedGoogle Scholar
  • 9 Robles-Rubio CA, Kaczmarek J, Chawla S. et al. Automated analysis of respiratory behavior in extremely preterm infants and extubation readiness. Pediatr Pulmonol 2015; 50 (05) 479-486
    CrossrefPubMedGoogle Scholar
  • 10 Vento G, Tana M, Tirone C. et al. Unexpected effect of recruitment procedure on lung volume measured by respiratory inductive plethysmography (RIP) during high frequency oscillatory ventilation (HFOV) in preterm neonates with respiratory distress syndrome (RDS). J Matern Fetal Neonatal Med 2011; 24 (Suppl. 01) 159-162
    CrossrefPubMedGoogle Scholar
  • 11 Warren RH, Horan SM, Robertson PK. Chest wall motion in preterm infants using respiratory inductive plethysmography. Eur Respir J 1997; 10 (10) 2295-2300
    CrossrefPubMedGoogle Scholar
  • 12 Hammer J, Newth CJ. Assessment of thoraco-abdominal asynchrony. Paediatr Respir Rev 2009; 10 (02) 75-80
    CrossrefPubMedGoogle Scholar
  • 13 Allen JL, Wolfson MR, McDowell K, Shaffer TH. Thoracoabdominal asynchrony in infants with airflow obstruction. Am Rev Respir Dis 1990; 141 (02) 337-342
    CrossrefPubMedGoogle Scholar
  • 14 Lampland AL, Plumm B, Worwa C, Meyers P, Mammel MC. Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 2015; 100 (01) F31-F34
    CrossrefPubMedGoogle Scholar
  • 15 Miedema M, van der Burg PS, Beuger S, de Jongh FH, Frerichs I, van Kaam AH. Effect of nasal continuous and biphasic positive airway pressure on lung volume in preterm infants. J Pediatr 2013; 162 (04) 691-697
    CrossrefPubMedGoogle Scholar
  • 16 Lista G, Castoldi F, Fontana P. et al. Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial. Arch Dis Child Fetal Neonatal Ed 2010; 95 (02) F85-F89
    CrossrefPubMedGoogle Scholar
  • 17 Wright CJ, Polin RA, Kirpalani H. Continuous positive airway pressure to prevent neonatal lung injury: how did we get here, and how do we improve?. J Pediatr 2016; 173: 17-24.e2
    CrossrefPubMedGoogle Scholar