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Noninvasive ventilation in neonates


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This gives a brief idea about the:
Techniques, Response To NIV, Clinical indications, Contraindications and Evidence Based Decisions on the use of noninvasive ventilation with neonates

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Noninvasive ventilation in neonates

  1. 1. Noninvasive Ventilation In Neonates
  2. 2. Objectives Techniques Response To NIV Clinical indications Contraindications Evidence Based Decisions
  3. 3. Techniques 1. CPAP 2. BiPAP 3. SNIPPV 4. HHHFNC
  4. 4. CPAP • Constant level of pressure support to the airways during inspiration and expiration • 5-10 cm H2O and up to 15 • Recomended NCPAP is 7 cm H2O • Different external interfaces • Hypoxemic respiratory failure
  5. 5. External interfaces
  6. 6. BiPAP • Provide two levels of positive airway pressure during the respiratory cycle • Higher level (IPAP): “2-25” cm H2O ≈ “10 -16” cm H2O • Lower level(EPAP): “2-20” cm H2O ≈ “5 to 10” cm H2O • Leak compensation • Hypercapnic respiratory failure • Comes in 3 types: 1. PS: pt. trigger 2. PC: set RR 3. BiPAP: IPAP +EPAP.
  7. 7. SNIPPV • Augmenting NCPAP (delivering ventilator breaths via nasal prongs). • Improves ( tidal volume, minute ventilation) and decrease WOB compared to NCPAP. • Intermittent peak inspiratory pressure.
  8. 8. HHHFNC • “HHFNC* provides airway-distending pressure and respiratory support in preterm neonates comparable to nasal CPAP” (Saslow et al., 2006). • Hypoxemic respiratory failure • Flow rate 1-8 L/min for neonates • Oxygen blinder • FiO2 up to 1.0
  9. 9. Is it working ?
  10. 10. Response To NIV
  11. 11. Clinical indications
  12. 12. Contraindications
  13. 13. Techniques Response To NIV Clinical indications Contraindications
  14. 14. Evidence Based Decisions RDS : •No differences between NSIPPV and BiPAP strategies in terms of duration of ventilation and failures, suggesting that both NIV techniques are effective in the early treatment of RDS in VLBW infants.
  15. 15. RDS: •HHFNC is well-tolerated by premature infants. Compared to infants managed with NCPAP. •No differences in deaths, ventilator-days, BPD, blood infections or other outcomes. More infants were intubated for failing early NCPAP compared to early HHFNC
  16. 16. Hypoxic respiratory failure: •In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients.
  17. 17. AOP (HFNC vs. NCPAP)
  18. 18. AOP: •HFNC is as effective as NCPAP in the management of AOP.
  19. 19. • NIPPV appears to reduce the frequency of apneas more effectively than NCPAP
  20. 20. Post Extubation: •HHHFNC appears to have similar efficacy and safety to NCPAP when applied immediately post extubation
  21. 21. • The meta-analysis demonstrates a statistically and clinically significant reduction in the risk of meeting extubation failure criteria
  22. 22. Thank you for listening