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 Anwendungen

NIPPV. Nasale intermittierende Positivdruckbeatmung

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Nasale intermittierende Positivdruckbeatmung

Der Oberbegriff NIPPV (Nasal Intermittend Positive Pressure Ventilation, nasale intermittierende Positivdruckbeatmung) umfasst Modi, bei denen – zusätzlich zum CPAP/PEEP – kontrollierte Atemhübe zur Unterstützung des Patienten verabreicht werden. Diese Atemhübe haben ein höheres Druckniveau und werden nicht synchronisiert abgegeben. Zwischen den unterschiedlichen Varianten dieser Form der Atemunterstützung wird differenziert (Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Semin Fetal Neonatal Med. 2016;21(3):146-153. doi:10.1016/j.siny.2016.01.0031​, 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(3):203-209. doi:10.1159/0003534482​, Davis PG, Morley CJ, Owen LS. Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation. Semin Fetal Neonatal Med. 2009;14(1):14-20. doi:10.1016/j.siny.2008.08.0033​).

NIPPV (Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Semin Fetal Neonatal Med. 2016;21(3):146-153. doi:10.1016/j.siny.2016.01.0031​, 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(3):203-209. doi:10.1159/0003534482​) definiert sich selbst in dieser Gruppe mit kurzen Inspirationszeiten (0,3–0,5 s) und Atemfrequenzen von 10–60 BPM. Idealerweise passt sich der Patient an die NIPPV-Frequenz an. NIPPV ist ein zeitkontrollierter Modus, was bedeutet, dass die Atemfrequenz in erster Linie über die Inspirationszeit eingestellt wird. 

  • Kontrollierte Atemunterstützung für Neonaten

  • Wirkungsvolle Unterstützung nach der Extubation und während Apnoe (1,2)

  • Bedienfreundlichkeit und einfache Anpassung

  • Verfügbar bei den Geräten medinCNO, medinCNOmini, medin-NC3

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Der BiLevel-Modus (Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Semin Fetal Neonatal Med. 2016;21(3):146-153. doi:10.1016/j.siny.2016.01.0031​, 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(3):203-209. doi:10.1159/0003534482​) unterscheidet sich von der NIPPV durch die längere Inspirationszeit (0,5 s–1 s) und entsprechend niedrigere Atemfrequenzen (10–30 BPM). Das Ziel ist es, dem Patienten das Atmen auf beiden Druckniveaus zu ermöglichen. Infolge der längeren Zeit mit höherem Druck kann sich der mittlere Atemwegsdruck erhöhen. 

1 Maschineller Atemhub
2 Spontanatmung auf dem zweiten, höheren Druckniveau

Wann wird NIPPV eingesetzt?

Die Auswirkungen und Wirksamkeit der NIPPV wurden in zahlreichen Studien untersucht (Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Semin Fetal Neonatal Med. 2016;21(3):146-153. doi:10.1016/j.siny.2016.01.0031​, 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(3):203-209. doi:10.1159/0003534482​, Davis PG, Morley CJ, Owen LS. Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation. Semin Fetal Neonatal Med. 2009;14(1):14-20. doi:10.1016/j.siny.2008.08.0033) . Indikationen sind: 

  • Apnoe-Bradykardie-Syndrom
  • Nach Extubation
  • Erstbehandlung von RDS

Das medin System

Die spezialisierten CPAP-Geräte von medin in Verbindung mit dem Medijet nCPAP-Generator sind ideal für den Einsatz von NIPPV und BiLevel geeignet. Beim Basisflow wird der Patient mit dem gewünschten CPAP/PEEP versorgt. Mithilfe eines zweiten Flowniveaus, das zusätzlich zum Basisflow über ein weiteres elektronisches Flowmeter eingestellt wird, erzeugt Medijet ein höheres Druckniveau.

Da Medijet zu jeder Zeit die Exspiration zulässt, kann der Patient bei beiden Druckniveaus frei atmen. Dadurch ermöglichen die medin CPAP-Geräte alle Optionen der NIPPV-Atemunterstützung.

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  • Basisflow: In l/min. Erzeugt den CPAP/PEEP im Medijet nCPAP-Generator
  • Push-Flow: In l/min. Erzeugt ein zweites Druckniveau, PIP, im Medijet nCPAP-Generator, zusätzlich zum Basisflow
  • Amplitude: In Stufen von 1 bis 10. Definiert die Größe der Druckamplitude über die Schließtiefe des Hochfrequenzventils. Stufe 10 = höchste Amplitude; Stufe 1 = niedrigste Amplitude
  • Frequenz: In BPM. Anzahl der Atemhübe pro Minute in Abhängigkeit von der Inspirationszeit
  • Sauerstoffzufuhr

Referenzen

  1. 1. Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Semin Fetal Neonatal Med. 2016;21(3):146-153. doi:10.1016/j.siny.2016.01.003
  2. 2. 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(3):203-209. doi:10.1159/000353448

 

  1. 3. Davis PG, Morley CJ, Owen LS. Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation. Semin Fetal Neonatal Med. 2009;14(1):14-20. doi:10.1016/j.siny.2008.08.003

Fußnoten

 

Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization.

Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Semin Fetal Neonatal Med. 2016;21(3):146-153. doi:10.1016/j.siny.2016.01.003

The use of nasal intermittent positive pressure ventilation (NIPPV) as respiratory support for preterm infants is well established. Evidence from randomized trials indicates that NIPPV is advantageous over continuous positive airway pressure (CPAP) as post-extubation support, albeit with varied outcomes between NIPPV techniques. Randomized data comparing NIPPV with CPAP as primary support, and for the treatment of apnea, are conflicting. Intrepretation of outcomes is limited by the multiple techniques and devices used to generate and deliver NIPPV. This review discusses the potential mechanisms of action of NIPPV in preterm infants, the evidence from clinical trials, and summarizes recommendations for practice.

Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013?

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(3):203-209. doi:10.1159/000353448

Nasal continuous positive airway pressure (NCPAP) has proven to be an effective mode of non-invasive respiratory support in preterm infants; however, many infants still require endotracheal ventilation, placing them at an increased risk of morbidities such as bronchopulmonary dysplasia. Several other modes of non-invasive respiratory support beyond NCPAP, including synchronised and non-synchronised nasal intermittent positive pressure ventilation (SNIPPV and nsNIPPV) and bi-level positive airway pressure (BiPAP) are now also available. These techniques require different approaches, and the exact mechanisms by which they act remain unclear. SNIPPV has been shown to reduce the rate of reintubation in comparison to NCPAP when used as post-extubation support, but the evidence for nsNIPPV and BiPAP in this context is less convincing. There is some evidence that NIPPV (whether synchronised or non-synchronised) used as primary respiratory support is beneficial, but the variation in study methodology makes this hard to translate confidently into clinical practice. There is currently no evidence to suggest a reduction in mortality or important morbidities such as bronchopulmonary dysplasia, with NIPPV or BiPAP in comparison to NCPAP, and there is a lack of appropriately designed studies in this area. This review discusses the different approaches and proposed mechanisms of action of SNIPPV, nsNIPPV and BiPAP, the challenges of applying the available evidence for these distinct modalities of non-invasive respiratory support to clinical practice, and possible areas of future research.

Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation.

Davis PG, Morley CJ, Owen LS. Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation. Semin Fetal Neonatal Med. 2009;14(1):14-20. doi:10.1016/j.siny.2008.08.003

Non-invasive techniques of respiratory support were developed in order to reduce the adverse effects associated with ventilation via an endotracheal tube. Short bi-nasal prongs provide the most effective nasal interface for delivery of nasal continuous positive airway pressure (nCPAP). Devices used to generate CPAP include conventional ventilators, the 'bubbly bottle' system and the infant flow driver. NCPAP improves the rate of successful extubation. It is useful for preterm infants with respiratory distress syndrome, reducing time spent on an endotracheal tube and oxygen requirement at 28d. However, nCPAP is associated with an increased rate of pneumothorax. Nasal intermittent positive pressure ventilation (NIPPV) is useful for augmenting the effectiveness of nCPAP. It further improves rates of successful extubation and shows promise as an initial method of respiratory support. Further research is required to determine the optimal settings for both nCPAP and NIPPV.