High CPAP vs. NIPPV in preterm neonates - A physiological cross-over study

Abstract

Objective: To evaluate the physiological impact of high CPAP (≥9 cmH2O) vs. NIPPV at equivalent mean airway pressures.

Study design: In this cross-over study, preterm neonates on high CPAP or NIPPV were placed on the alternate mode. After 30 min, left and right ventricular cardiac output and work of breathing indices were assessed, following which patients were placed back on the original mode and a similar procedure ensued.

Results: Fifteen infants with mean (SD) postmenstrual age 32.7 (3.0) weeks, and weight 1569 (564) grams were included. No differences in LVO [320 (63) vs. 331 (86) mL/kg/min, P = 0.46] or RVO [420 (135) vs. 437 (141) mL/kg/min, P = 0.19] were noted during high CPAP vs. NIPPV, along with no differences in work of breathing indices.

Conclusion: High CPAP pressures did not adversely impact cardiac output or work of breathing compared to NIPPV at equivalent mean airway pressure.

Conflict of interest statement

AM, MGAW, AR, ER, WP and TM have no potential competing interests to disclose. JB has made inventions related to neural control of mechanical ventilation that are patented. The patents are assigned to the academic institution(s) where inventions were made. The license for these patents belongs to Maquet Critical Care. Future commercial uses of this technology may provide financial benefit to Dr JB through royalties. Dr JB owns 50% of Neurovent Research Inc (NVR). NVR is a research and development company that builds the equipment and catheters for research studies. NVR has a consulting agreement with Maquet Critical Care.

© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.

Figures

Fig. 1. Study schema depicting the crossover between high CPAP and NIPPV at equivalent MAP.

CPAP continuous positive airway pressure, MAP mean airway pressure, NIPPV non-invasive positive pressure ventilation.

Fig. 2. Cardiac Output on High CPAP vs. NIPPV.

A LVO estimates were 320 [63] vs. 331 [86] mL/kg/min, P = 0.46 during high CPAP and NIPPV, respectively. B RVO values were 420 (135) vs. 437 (141) mL/kg/min, P = 0.19 with high CPAP and NIPPV, respectively. CPAP continuous positive airway pressure, LVO left ventricular output, NIPPV nasal intermittent positive pressure ventilation, RVO right ventricular output.

Fig. 3. Peak and minimum Edi on High CPAP vs. NIPPV.

A Peak Edi values assessed during inhalation were 16.6 (8.6) vs. 14.2 (6.0) µV, P = 0.19 during high CPAP and NIPPV, respectively. B Minimum Edi values assessed in expiratory phase were 6.2 (3.0) vs. 5.4 (2.8) µV, P = 0.39 during high CPAP and NIPPV, respectively. CPAP continuous positive airway pressure, Edi electrical activity of diaphragm, NIPPV nasal intermittent positive pressure ventilation.