Continuous positive airway pressure: scientific and clinical rationale.
OBJECTIVE
To present recent data on the role of noninvasive ventilation in the respiratory management of newborn infants.


RESULTS
Noninvasive ventilation is growing in popularity but is applied using widely varying devices and settings. Although short-term physiological advantages were reported for bubble and variable-flow continuous positive airways pressure, neither has convincingly shown superior clinically important outcomes. Continuous positive airways pressure may be used as the initial mode of support for very preterm infants but increased rates of pneumothorax in infants not receiving surfactant are a concern. Methods of administering surfactant without endotracheal intubation deserve further study. Nasal intermittent positive-pressure ventilation shows promise as a primary treatment for respiratory distress syndrome. Optimal pressure settings for continuous positive airways pressure and nasal intermittent positive-pressure ventilation remain uncertain.


CONCLUSIONS
Noninvasive ventilation has partially fulfilled its promise as a gentler alternative to ventilation via an endotracheal tube. Appropriately designed randomized clinical trials are required to determine the best nasal interfaces and pressure generators.
Morley
Colin J
CJ
Neonatal Services, The Royal Women's Hospital, Carlton, Victoria, Australia. colin.morley@rwh.org.au
Davis
Peter G
PG
D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D003696:Delivery Rooms / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D009609:Nitrous Oxide / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012151:Resuscitation / Q000379:methods; D012306:Risk; D016896:Treatment Outcome
D011663:Pulmonary Surfactants; D009609:Nitrous Oxide