وصف
Non-invasive ventilation (NIV) is a vital respiratory support method for newborns with breathing difficulties. It provides assistance without the need for intubation, reducing the risks of complications such as ventilator-associated infections. Common methods include Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BiPAP). NIV is often used to treat premature infants with respiratory distress syndrome or apnea. This approach promotes better lung development and improves overall neonatal outcomes while minimizing invasiveness.
ملخص
- Neonatal respiratory distress is a significant clinical challenge, with 90% of NICU admissions stemming from it. Balancing respiratory support with the risks of invasive ventilation, which can lead to bronchopulmonary dysplasia (BPD), is crucial. Non-invasive ventilation is a cornerstone in managing this distress, aiming to support the baby without resorting to invasive measures.
- Common modes of non-invasive ventilation include CPAP, which provides continuous distending pressure to keep the lungs open, and NIPPV, which adds extra pressure on top of CPAP, simulating ventilation through the nose. High-flow nasal cannula (HFNC) delivers high flows of gas to improve gas exchange and reduce the work of breathing. Advanced options like nasal high-frequency oscillatory ventilation and NAVA are also emerging.
- CPAP helps maintain lung volume above the closing volume, facilitating gas exchange. NIPPV, by delivering additional pressure above CPAP, enhances tidal volume and lung recruitment. However, leaks at the nasal interface can lead to variable pressure delivery, emphasizing the importance of synchronized respiratory efforts.
- The parameters for NIPPV include setting a PEEP similar to CPAP (6-7 cm of water), a PIP of 18-20 cm of water, an inspiratory time of 0.4 seconds, a rate of 40-50 breaths per minute, and adjusting FiO2 to maintain saturation between 90-95%. In the weaning process the FiO2 is addressed first followed by the rate.
- Conventional ventilators can be used for NIPPV in CMV mode, acknowledging the absence of a flow sensor for synchronization. Dedicated non-invasive ventilators offer synchronization using specialized sensors, though these are less common. Leak compensation is an important feature in any NIPPV device to mitigate issues like aerophagia. Failure criteria for NIPPV include increasing retractions, oxygen requirements, and circulatory problems.
- HFNC, an alternative to CPAP, involves delivering heated and humidified high flows of gas through nasal prongs. It works by flushing out dead space and reducing the work of breathing, without a precise pressure measurement like CPAP. Studies have shown HFNC may be comparable to CPAP in larger babies, but CPAP is preferred for smaller babies, those with significant respiratory distress, or when FiO2 requirements are high.
- Future directions in non-invasive ventilation include nasal high-frequency ventilation and NAVA, which monitors diaphragmatic excursions to optimize respiratory support. Proper nursing care, timely surfactant administration, and caffeine use are also crucial components of managing respiratory distress. Parental values and communication are important to consider.
- Complications of NIV include nasal injuries, gastric distinction and, in some instances, pneumothorax. Respiratory conditions in neonates that benefit from NIV include RDS, Transient Tachypnea of the Newborn and sometimes in meconium aspiration syndrome.
نموذج شهادة
حول المتحدثين
Dr. Saikiran Deshabhotla
Lead Consultant Neonatologist, Fernandez Hospital, Hyderabad
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