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Applications. To cover the entire therapy spectrum of non-invasive respiratory support

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ApneaCPAP

Apnea and breathing irregularities affect nearly every premature infant and newborn. The more premature the infant is, the more markedly apnea occurs. They represent a disruption in the respiratory mechanics as well as respiratory control. The most important feature of the apnea is the intermittent air flow in the patient’s airway.

More information about AppneaCPAP
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nCPAP

nCPAP (nasal Continuous Positive Airway Pressure) is the most commonly used mode of non-invasive respiratory support in premature infants and newborns as well as the basis for several further variants such as NIPPV, SNIPPV and NHFV. When using nCPAP, the patient must be able to breathe spontaneously, since no breaths are administered.

More information on nCPAP
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Nasal high-flow therapy (nHFT)

Nasal high-flow therapy (nHFT) describes the supply of heated and humidified breathing gas via a nasal cannula. The gas flow administered is thus higher than the patient’s inspiratory respiratory flow. In neonatology, a flow of more than 1 LPM is considered to be high-flow therapy, while for adults, correspondingly higher values should be applied. (Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.0061​)

Other names for nHFT: High-Flow Nasal Cannula (HFNC) or Heated Humidified High-Flow Nasal Cannula. All of them designate the same form of therapy.

More information on nHFT

Nasal high frequency ventilation (nHFV)

nHFV combines the benefits of high‑frequency ventilation and non‑invasive CPAP support (De Luca D, Dell'Orto V. Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data. Arch Dis Child Fetal Neonatal Ed. 2016;101(6):F565-F570. doi:10.1136/archdischild-2016-3106642​). The patient breathes spontaneously with CPAP support. A special valve shifts the air flow in all phases of spontaneous breathing under high‑frequency oscillations (<200 BPM).  

More information on nHFV
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NIPPV – Nasal Intermittend Positive Pressure Ventilation

The umbrella term NIPPV includes modes in which -  in addition to CPAP/PEEP - controlled breaths are applied to support the patient. These breaths have a higher pressure level and are not emitted in a synchronized manner. A differentiation is made between the different variants of this form of respiratory support.

More information on NIPPV

SNIPPV – Synchronized Nasal Intermittend Positive Pressure Ventilation

SNIPPV is the synchronized variant of NIPPV respiratory support. In NIPPV, the breaths are administered by the device independent of the patient’s own breathing. This can lead to conflicts in the synchronization between the patient and the device. In SNIPPV, the breaths are coordinated to the patient’s inspiration and conflicts are minimized.

More information on SNIPPV
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Active humidification

Breathing gas conditioning refers to the heating and humidification of the inspired air or the breathing gas administered. This can be done either actively using a humidifier or passively with an HME filter (heat and moisture exchanger).

Since the respiratory system of premature infants and newborns is frequently not yet fully developed or is at least very sensitive, active humidification systems are preferably used for small patients.

HAMILTON-H900 More about active humidification

References

  1. 1. Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.006

 

  1. 2. De Luca D, Dell'Orto V. Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data. Arch Dis Child Fetal Neonatal Ed. 2016;101(6):F565-F570. doi:10.1136/archdischild-2016-310664

Footnotes

 

Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015.

Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.006

Nasal high-flow therapy (nHFT) has become a popular form of noninvasive respiratory support in neonatal intensive care units. A meeting held in Oxford, UK, in June 2015 examined the evidence base and proposed a consensus statement. In summary, nHFT is effective for support of preterm infants following extubation. There is growing evidence evaluating its use in the primary treatment of respiratory distress. Further study is needed to assess which clinical conditions are most amenable to nHFT support, the most effective flow rates, and escalation and weaning strategies. Its suitability as first-line treatment needs to be further evaluated.

Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data

De Luca D, Dell'Orto V. Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data. Arch Dis Child Fetal Neonatal Ed. 2016;101(6):F565-F570. doi:10.1136/archdischild-2016-310664

Non-invasive high-frequency oscillatory ventilation (NHFOV) consists of the application of a bias flow generating a continuous distending positive pressure with superimposed oscillations, which have constant frequency and active expiratory phase. NHFOV matches together the advantages of high-frequency ventilation (no need for synchronisation, high efficacy in removing CO2) and nasal continuous positive airway pressure (CPAP) (non-invasive interface, increase in functional residual capacity allowing oxygenation to improve). There is enough clinical expertise demonstrating that NHFOV may be tried in some selected cases, in whom CPAP or conventional non-invasive ventilation have failed. Nonetheless, there are no clear data about its clinical usefulness and there is a need for randomised controlled studies. Our purpose is to review the physiology and biological effects of NHFOV, to present the current clinical evidence on its use, to provide some guiding principles to clinicians and suggest directions for further research.