Respiratory Support for Infants With Pulmonary Insufficiency
There have been many improvements in the patient interfaces available for use with non-invasive support in the neonatal population over the last decade. Skin friendly materials, anatomically designed masks and prongs, and size specific disposables make it possible to create the best fit for the majority of patients. Extremely low birth weight (ELBW) infants present unique challenges as even the smallest nasal prongs are too large in some instances. The advent of nasal masks has helped to fill the need in these patients, however, maintaining a proper seal while avoiding excessive pressure can be difficult. Improvements in design have prompted some users to incorporate nasal cannulas as an interface for NIPPV using a conventional mechanical ventilator in ELBW infants with some success. More research is needed to establish this as a safe and effective practice.
One interesting finding in the Pandit et al study was the potential for lung over-distention at CPAP pressures of 6–8 cm H2O with the variable flow device. It should be noted that the type of patient interface being used significantly influences the pressure required to adequately maintain lung volume. Devices using an interface associated with higher resistance (i.e. long prong binasal airway) will require a higher set CPAP pressure at the device in order to achieve the desired physiologic pressure in the lung. Clinicians must be aware that no two CPAP devices or patient interfaces are the same – clinical evaluation and patient assessment are the keys to determining what is indicated for each patient (see Table 2).
Patient Interfaces
There have been many improvements in the patient interfaces available for use with non-invasive support in the neonatal population over the last decade. Skin friendly materials, anatomically designed masks and prongs, and size specific disposables make it possible to create the best fit for the majority of patients. Extremely low birth weight (ELBW) infants present unique challenges as even the smallest nasal prongs are too large in some instances. The advent of nasal masks has helped to fill the need in these patients, however, maintaining a proper seal while avoiding excessive pressure can be difficult. Improvements in design have prompted some users to incorporate nasal cannulas as an interface for NIPPV using a conventional mechanical ventilator in ELBW infants with some success. More research is needed to establish this as a safe and effective practice.
One interesting finding in the Pandit et al study was the potential for lung over-distention at CPAP pressures of 6–8 cm H2O with the variable flow device. It should be noted that the type of patient interface being used significantly influences the pressure required to adequately maintain lung volume. Devices using an interface associated with higher resistance (i.e. long prong binasal airway) will require a higher set CPAP pressure at the device in order to achieve the desired physiologic pressure in the lung. Clinicians must be aware that no two CPAP devices or patient interfaces are the same – clinical evaluation and patient assessment are the keys to determining what is indicated for each patient (see Table 2).
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