This document discusses non-invasive ventilation (NIV) in neonates. It begins by defining NIV and describing the different modes including nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP). It reviews the evidence that NIPPV compared to NCPAP reduces extubation failure rates, failure rates as a primary respiratory mode, and mortality/bronchopulmonary dysplasia. The document provides guidelines for using NIPPV as a primary respiratory mode in preterm infants.
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
This is a detailed presentation on Non-Invasive Ventilation in Neonates. it includes modes of NIV, Evidence related to CPAP vs NIV, use of NIV/CPAP and detailed description of CPAP and its use, complications associated with NIV and related management
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
This is a detailed presentation on Non-Invasive Ventilation in Neonates. it includes modes of NIV, Evidence related to CPAP vs NIV, use of NIV/CPAP and detailed description of CPAP and its use, complications associated with NIV and related management
CLINICAL TEACHING ON BUBBLE CPAP: Introduction, Definition, History of development, Physiology of Bubble CPAP, Principle, Patient interface, equipments for bubble CPAP, indication and contraindication for bubble CPAP, essential of CPAP, CPAP machine, bubble cpap machine application, setting pressure, FiO2, oxygen flow, Monitoring adequacy and complications of bubble CPAP, Monitoring infant condition, weaning for Bubble CPAP, CPAP Failure, complications related to CPAP, Preventing complications, Nursing Care.
CLINICAL TEACHING ON BUBBLE CPAP: Introduction, Definition, History of development, Physiology of Bubble CPAP, Principle, Patient interface, equipments for bubble CPAP, indication and contraindication for bubble CPAP, essential of CPAP, CPAP machine, bubble cpap machine application, setting pressure, FiO2, oxygen flow, Monitoring adequacy and complications of bubble CPAP, Monitoring infant condition, weaning for Bubble CPAP, CPAP Failure, complications related to CPAP, Preventing complications, Nursing Care.
this is compiled & created to discuss the basic modes and initiation of NIV
the author is thankful to the previous authors,teachers who helped to conceptualize the NIV .
Similar to NON INVASIVE VENTILATION IN NEONATE (20)
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
3. Non invasive ventilation: WHY INTEREST IN NIV??
3
In the United Kingdom, 48% of 91 use NIPPV(2009)
in Ireland 61% of 28units surveyed reported using NIPPV(2011)
in Brazil 98.7% of 81 units used NIPPV(2012)
No such data are available from the United States
4. Non invasive ventilation: WHY & WHAT?
4
CPAP does not consistently improve ventilation and does not work in
infants with poor respiratory effort
(46-60% of babies with RDS may fail CPAP and
25-40% of intubated LBW babies fail extubation to CPAP)
Invasive ventilation causes baro/volutrauma, atelecto-trauma along
with bio-trauma resulting in ventilator induced lung injury( VILI).
In an effort to support ventilation and avoid need for invasive support
the use of intermittent positive pressure ventilation via nasal
devices has been proposed (positive pressure cycle delivered on
topofcontinuousdistendingpressurebynasalroute)
5. No inflation
5 inflations of
32 ml/kg
Bjorklund LJ, et al: Acta Anaesthesiol Scand 45:986, 2001
Non invasive ventilation: WHY INTEREST IN NIV??
8. Non invasive ventilation: HOW?-machines delivering SNIPPV
8
Infant Star ventilator (CareFusion, Yorba Linda, CA) with the Star- Sync
module (CareFusion, Yorba Linda, CA) for synchronization
Sechrist IV-200 SAVI ventilator (Sechrist Industries, Anaheim, CA)
Nasal-flow synchronized ventilator (Giulia; Ginevri, Rome, Italy)
Servo-i ventilator (Maquet Medical Systems, Wayne, NJ) with neurally
adjusted ventilator assist(NAVA)
Infant Flow SiPAP Comprehensive (CareFusion, San Diego, CA)
ventilator (available in Europe and Canada, but not in the United States)- a bilevel
device providing higher and lower pressures with much longer inspiratory
times compared with SNIPPV mode. The PIPs generated by the SiPAP device
are between 9 to 11 cm H2O.
phased out, most of the S N I P P V
studies have used it. Recently
N I P P V studies have emerged as
INFANT STAR was phased out
NIV-NAVA, an extra module ,added to Servo-i for
synchronization was used in a small study of five
low-birth-weight infants
9. Non invasive ventilation: HOW? machines delivering NIPPV
9
SLE 2000 (Specialized Laboratory Equipment, South Croydon, UK)
VIP Bird -R Sterling (Viasys Health Care, Conshohocken, PA)
Drager Babylog 8000 (Drager Medicals, Lubeck, Germany)
Inter Neo (Intermed,Sao Paulo, Brazil)
Avea ventilator (CareFusion, San Diego, CA)
Bear Cub 750 PSV
Servo-i ventilator (Maquet Medical Systems, Wayne, NJ)
10. Non invasive ventilation: CLINICAL INDICATIONS:
10
APNEA OF
PREMATURITY
RESPIRATORY
DISTRESS SYNDROME
POST EXTUBATION
NNT=3 !
11. Non invasive ventilation: HOW? Physiological effects of NIV
11
1. Apnea: Nasal IPPV may improve patency of the upper airway
by creating intermittently elevated pharyngeal pressures. This
intermittent inflation of the pharynx may activate respiratory
drive, by Head’s paradoxical reflex, where lung inflation
provokes an augmented inspiratory reflex. This results in
resumption of breathing in infants with apnea following
cycling of the ventilator.
2. Work of breathing has also been shown to be decreased with
the use of SNIPPV compared to nasal CPAP (Kiciman NM
Pediatr Pulmonol 1998; 25: 175–81)
12. Non invasive ventilation: HOW? Physiological effects of NIV
12
3. Chest wall distortion: The negative pressure generated during spontaneous
inspiration often produces an inward motion of the chest wall weakening
the inspiratory effort and delaying lung expansion. N-SIMV at 10 breaths per
minute reduced thoraco-abdominal asynchrony in preterm infants compared
to N-CPAP immediately after extubation.
Inefficient ventilation and waste of work
13. (the non-coincident motion of the rib cage and abdomen during breathing)
the rib cage is sucked in or retracted as
abdominal excursions occur (e.g., in
upper airway obstruction), or the
abdomen is retracted as the rib cage
expands (e.g., diaphragmatic paralysis)
Prisk GK Pediatric Pulmonology 2002; 34:462–472
Non invasive ventilation: physiology:Thoraco-abdominal Asynchrony
14. 25 weeks: Abdominal (red) & Chest Wall (green) Movements
Synchronized NIPPV: Better ventilation
NCPAP NIPPV
Courtesy of Simon Bignall
Thoraco-abdominal Asynchrony Synchrony
Non invasive ventilation: physiology
15. Non invasive ventilation: Primary Mode VS Secondary Mode
15
NIPPV in the primary mode refers to its use soon after birth with or
without a short period ( 2 hours) of intubation for surfactant delivery,
followed by extubation.
The secondary mode refers to its use after a longer period (>2 hours to
days to weeks) of intubation.
17. Non invasive ventilation: EvidenceBasedDecisions
NIPPV STUDIES IN NEONATE
17
Adopted from: Noninvasive Respiratory Support in the P r e term Infant, Bhandari.V. Clin Perinatol 39 (2012) 497–511
18. Non invasive ventilation: EvidenceBasedDecisions
SNIPPV STUDIES IN NEONATE(primary mode)
18
Adopted from: Noninvasive Respiratory Support in the P r e term Infant, Bhandari.V. Clin Perinatol 39 (2012) 497–511
19. Non invasive ventilation: EvidenceBasedDecisions
SNIPPV STUDIES IN NEONATE(secondary mode)
19
Adopted from: Noninvasive Respiratory Support in the P r e term Infant, Bhandari.V. Clin Perinatol 39 (2012) 497–511
21. 21
META-ANALYSIS?
The meta-analysis demonstrates a statistically and clinically significant reduction in
the risk of meeting extubation failure criteria [typical RR 0.21 (95% CI 0.10, 0.45),
NNT 3 (95% CI 2, 5)]
NIPPV may be a useful method of augmenting the beneficial effects of NCPAP in
preterm infants with apnea that is frequent or severe. Its use appears to reduce the
frequency of apneas more effectively than NCPAP. Additional safety and efficacy
data are required before recommending NIPPV as standard therapy for apnea.
22. Non invasive ventilation: EvidenceBasedDecisions : NIPPV VS NCPAP
22
EXTUBATION FAILURE RATE:NIPPV VS NCPAP
Nasal Intermittent Positive Pressure Ventilation versus Nasal Continuos Positive Airway Pressure in Neonates: A
Systematic Review and Meta-analysis: Tang et al, Indian pediatrics,2012
Five papers reported the rate of extubation failure of NIPPV
versus nCPAP following ETT and mechanical ventilation.
Meta-analysis showed that the rate of extubation
failure of NIPPV was significantly lower than that of
nCPAP [OR=0.15 (95% CI: 0.08 0.31)]; P<0.001.
23. Non invasive ventilation: EvidenceBasedDecisions : NIPPV VS NCPAP
23
FAILURE RATE as a primary mode in RDS :NIPPV VS NCPAP
Nasal Intermittent Positive Pressure Ventilation versus Nasal Continuos Positive Airway Pressure in Neonates: A
Systematic Review and Meta-analysis: Tang et al, Indian pediatrics,2012
Six papers reported the failure rate of NIPPV versus nCPAP as a primary
respiratory mode, which was indicated by whether or not requiring ETT and
mechanical ventilation.
Metaanalysis showed that the failure rate in NIPPV group was
significantly lower than that in nCPAP group as a primary
respiratory mode [OR=0.44 (95% CI: 0.31-0.63); P<0.0001)
24. Non invasive ventilation: EvidenceBasedDecisions : NIPPV VS NCPAP
24
META-ANALYSIS OF SECONDARY OUTCOMES BETWEEN NIPPV AND NCPAP GROUPS
Nasal Intermittent Positive Pressure Ventilation versus Nasal Continuos Positive Airway Pressure in Neonates: A
Systematic Review and Meta-analysis: Tang et al, Indian pediatrics,2012
• FINAL OUTCOME (DEATH AND/OR BPD): NIPPV was significantly better than that of
nCPAP as a primary respiratory mode [OR=0.57 (95% CI: 0.37-0.88); P=0.01]
• APNEA OF PREMATURITY: NIPPV showed a statistically lower rate of apnea (episodes
per hour) as compared with nCPAP group [WMD=-0.48 (95%CI:-0.58-0.37; P<0.001]
• DURATION OF HOSPITALIZATION : (primary respiratory mode /extubation mode) : No
significant difference in duration of hospitalization between NIPPV and nCPAP group
[WMD=-0.51 (95%CI:-5.62-4.61;
• INCIDENCE OF BPD : NIPPV led to a marginally significant reduction in the incidence
of BPD as compared with nCPAP. [OR(95%CI)=0.39-1.00,P=0.05]
• incidence of IVH, PVL, ROP, PDA, Pneumothorax or air leak, abdominal distention,
necrotizing enterocolitis : no significant differences
25. Non invasive ventilation: SNIPPV VERSUS NIPPV
“does synchronization matter?”
25
There is only one retrospective study [from YALE NEW HAVEN NICU](Dumpa
V, Katz K, Northrup V, et al. SNIPPV vs NIPPV: does synchronization matter? J
Perinatol 2012;32(6):438–42).
At Yale, before 2007, NIPPV was delivered through a ventilator, which synchronized
breaths with infant’s respiratory efforts (SNIPPV), using the Infant Star ventilator
with StarSync and synchronization with infant’s respiratory efforts was achieved
utilizing the Graseby capsule. NIPPV replaced SNIPPV, as the Infant Star ventilator
was phased out of production in the United States. From 2007, NIPPV has been
utilized using the Bear Cub 750 psv ventilator.
Retrospectively they compared the clinical outcomes of the two
eras (SNIPPV=2004-2006) and (NIPPV=2007-2009).
26. Non invasive ventilation: SNIPPV VERSUS NIPPV
“does synchronization matter?”
26
Study groups: There was no significant difference in the mean gestational
age and birth weight in the two groups: SNIPPV (n = 172; 27w; 1016 g) and
NIPPV (n = 238; 27.7w; 1117 g).
There were no significant differences in maternal demographics, use of
antenatal steroids, gender, multiple births, small for gestational age or
Apgar scores in the two groups.
More infants in the NIPPV(63%) group were given resuscitation in the
delivery room as compared to SNIPPV(44%). Use of surfactant (84.4 vs
70.2%; P<0.001) was significantly higher in the SNIPPV group.
27. Non invasive ventilation: SNIPPV VERSUS NIPPV
“does synchronization matter?”
27
Results: After adjusting for significant confounding variables,
use of NIPPV versus SNIPPV (odds ratio, 0.74; 95% confidence
interval, 0.42–1.30) was not associated with BPD/death or
other common neonatal morbidities.
Conclusion: These data suggest that use of SNIPPV vs NIPPV is not
significantly associated with a differential impact on clinical outcomes
28. Non invasive ventilation: NIPPV VS SNIPPV (PHYSIOLOGY)
28
There have been two reports, comparing SNIPPV with NIPPV, evaluating
short-term effects.
1) Chang et al. studied the effects of synchronization during nasal ventilation
comparing NIPPV,SNIPPV,NCPAP in a randomized manner, each for 1 h. They
concluded that SNIPPV reduced breathing effort and resulted in
better infant –ventilator interaction than NSIPPV.
2) Owen et al effects of NIPPV on spontaneous breathing and proposed that
synchronization of NIPPV pressure peaks with spontaneous
inspirations may increase the benefits of NIPPV
29. Non invasive ventilation: flow synchronized nasal ventilation
newer alternative?
29
Gizzi et al (Flow-Synchronized Nasal Intermittent Positive Pressure Ventilation for Infants <32 Weeks’
Gestation with Respiratory Distress Syndrome, Crit care res and prac, 2012) retrospectively evaluated
whether SNIPPV(“Giulia” Neonatal Nasal Ventilator-Ginevri Medical Technologies,
Rome, Italy) used after the INSURE procedure can reduce mechanical ventilation
(MV) need in preterm infants<32wks with RDS more effectively than NCPAP and also
compared the clinical course and the incidence of short-term outcomes of infants
managed with SNIPPV or NCPAP.
INSURE failure was defined as FiO2 need >0.4,
respiratory acidosis, or intractable apnea that
occurred within 72 hours of surfactant
administration.
30. Non invasive ventilation: EvidenceBasedDecisions
flow synchronized nasal ventilation-newer alternative?
30
Results:
35.5% infants in the NCPAP group and 6.1%infants in the SNIPPV group
failed the INSURE approach and underwent MV (P < 0.004).
Fewer infants in the INSURE/SNIPPV group needed a second dose of surfactant, a
high caffeine maintenance dose, and pharmacological treatment for PDA.
Differences in O2 dependency at 28 days and 36 weeks of postmenstrual age were at
the limit of significance in favor of SNIPPV treated infants.
Conclusions. Flow Synchronized Nasal Ventilation use after INSURE technique
reduced MV need and favorably affected short-term morbidities of premature
infants
31. Non invasive ventilation: GUIDELINES:
(S)NIPPV (primary mode)
31
1. Settings:
Frequency = 40 per minute
PIP 4 cm H2O > PIP required during manual ventilation
(adjust PIP for effective aeration per auscultation)
PEEP 4–6 cm H2O
Ti = 0.45 s
FiO2 adjusted to maintain SpO2 of 85–93%
Flow 8–10 lpm
2. Caffeine loading → maintenance
3. Hematocrit 35%
4. Monitor SpO2, HR and respirations
5. Obtain blood gas in 15–30 min
6. Adjust ventilator settings to maintain blood gas parameters within normal limits
7. Suction mouth and pharynx and insert clean airway Q4, as necessary
8. Maximal support recommendations:
1000 g MAP 14 cm H2O
>1000 g MAP 16 cm H2O
Adopted from: Noninvasive Respiratory Support in the P r e term Infant, Bhandari.V. Clin Perinatol 39 (2012) 497–511
32. Non invasive ventilation: GUIDELINES:
(S)NIPPV (secondary mode)
32
1. Extubation criteria while on CV:
Frequency =15–25 per minute
PIP 16 cm H2O
PEEP 5 cm H2O
FiO2 0.35
Caffeine loading →maintenance
Hematocrit 35%
2. Place on (S)NIPPV
Frequency =15–25 per minute
PIP 2–4 > CV settings; adjust PIP for effective aeration per auscultation
PEEP 5 cm H2O
FiO2 adjusted to maintain SpO2 of 85–93%
Flow 8–10 lpm
3. Suction mouth and pharynx and insert clean airway Q4, as necessary
4. Maximal support recommendations:
1000 g MAP 14 cm H2O
>1000 g MAP 16 cm H2O
Adopted from: Noninvasive Respiratory Support in the P r e term Infant, Bhandari.V. Clin Perinatol 39 (2012) 497–511
33. Non invasive ventilation: GUIDELINES:
REINTUBATION CRITERIA
33
1. pH <7.25; PaCO2 >60 mm Hg
2. Episode of apnea requiring bag and mask ventilation
3. Frequent (>2–3 episodes per hour) apnea/bradycardia (cessation of respiration
for>20 s associated with a heart rate <100 per minute) not responding to caffeine
therapy
4. Frequent desaturation (<85%)=3 episodes per hour not responding to increased
ventilator settings
Adopted from: Noninvasive Respiratory Support in the P r e term Infant, Bhandari.V. Clin Perinatol 39 (2012) 497–511
34. Non invasive ventilation: GUIDELINES:
(S)NIPPV WEANING to oxy hood/nasal cannula
34
1. Minimal (S)NIPPV settings
Frequency 20 per minute
PIP 14 cm H2O
PEEP 4 cm H2O
FiO2 0.3
Flow 8–10 lpm
Blood gases within normal limits
2. Wean to:
Oxy hood adjust FiO2 to keep SpO2 85–93%
NC adjust flow (1–2 l m–1) and FiO2 to keep SpO2 85–93%
Adopted from: Noninvasive Respiratory Support in the P r e term Infant, Bhandari.V. Clin Perinatol 39 (2012) 497–511
35. Non invasive ventilation: in which preterms do we choose NIPPV?
35
MORE SUCCESSFUL IN 28-34 WKS & >1000 GM
36. 36
Non invasive ventilation: SIPAP
Two alternating levels of CDP
Also called Bi-level-NCPAP
Phasic change in delivered pressure
TI RATE PRESSURE
NIV SIMULATES IMV,WITHOUT ET 0.3-0.5 30-60 MAP=14
ATLEAST
SIPAP 2 LEVELS OF CDP, OVER WHICH
BABY BREATHES SPONTANEOUSLY
0.5-1 10-30 11 AND 4
ABOVE IT
4
better recruitment
Higher Tidal volume
Reduced work of breathing
37. Non invasive ventilation: NASAL BIPAP vs CPAP
37
Lista etal,Arch Dis Child Fetal Neonatal Ed. 2010 Mar;95(2)
38. Non invasive ventilation: NASAL BIPAP vs SNIPPV
38
28.6+/-1.8 WKS…78 NEWBORNS…RETROSPECTIVE
Ricotti Etal
39. Non invasive ventilation: NASAL HIGH FREQUENCY VENTILATION
39
In a small study by Colaizy (Acta Paediatr 2008;97:1518–1522) ,14 very low-birth-weight
infants, who were stable on NCPAP, were placed on NHFV (using the
Infant Star) for 2 h. The investigators noted that NHFV was effective in
decreasing pCO2.
These results are similar to an earlier report(Van der hooven 1998)
A significant amount of additional research needs to be done to
determine the clinical utility of this technique, if any, in the prevention
and/or treatment of BPD.
40. Non invasive ventilation: NAVA
40
NAVA/Neurally adjusted
ventilator assist is a mode of
synchronisation which uses
diaphragmatic
electromyography to
synchronise not only the time
of breath according to
patients initiation of
inspiration ,but also it gives
breath proportionate to
electrical activity of
diaphragm.
41. Non invasive ventilation: EvidenceBasedDecisions:follow up: BPD
41
Bhandari(2007) compared invasive with non invasive in
terms of long term outcome and opined that those with
early extubation to SNIPPV had 20% chance of BPD/DEATH
as compared to 52% among those who were cont on MV.