title: Effects of synchronisation during SiPAP-generated nasal intermittent positive pressure ventilation (NIPPV) in preterm infants.
abstract: OBJECTIVE
  The SiPAP flow driver (Care Fusion, Dublin, Ohio, USA) offers synchronised nasal intermittent positive pressure ventilation (sNIPPV) using an abdominal capsule. This study aims to describe the accuracy and effects of synchronised NIPPV using SiPAP in preterm infants.
  
  
  METHODS
  Ten infants, born <28 weeks' gestation, receiving synchronised SiPAP-generated NIPPV, in 'biphasic trigger' mode, were observed. Abdominal capsule signals, delivered pressures, respiratory pattern and oxygen saturations were recorded. Tidal volume (VT), apnoeas, proportion of breaths supported by SiPAP and time between inspiration onset and SiPAP pressure rise were analysed.
  
  
  RESULTS
  Infants were of median 26(+0) weeks' gestational age and birth weight 776 g. Mean (SD) respiratory rate (RR) was 53 (14)/min. 82% (17) of spontaneous breaths triggered a SiPAP pressure peak. Mean time between inspiration and SiPAP pressure rise was 28 (20) ms. There was no difference in VT when breaths triggered a SiPAP pressure peak compared with breaths without a pressure peak. No VT was generated by pressure peaks delivered during apnoea. Capsule signals were not recognised following >10% of breaths, resulting in asynchronous NIPPV delivery. Movements resulted in irregular SiPAP pressures and desaturation. When the RR was faster, >55/min, breaths irregularly triggered a SiPAP pressure peak (p=0.003). Compared with times when every breath resulted in a pressure peak, lower mean pressures were achieved, 7.9 vs 8.4 cm H2O (p=0.02).
  
  
  CONCLUSIONS
  The SiPAP synchronisation system triggered rapidly with most spontaneous breaths, but did not result in larger tidal volumes. When the RR was >55/min, the SiPAP delivered fewer pressure peaks at lower pressures.
authors.affiliation: The Royal Women's Hospital, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia University of Melbourne, Melbourne, Australia.
authors.forename: L S
authors.initials: LS
authors.lastname: Owen
authors.affiliation: The Royal Women's Hospital, Melbourne, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Morley
authors.affiliation: The Royal Women's Hospital, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia University of Melbourne, Melbourne, Australia.
authors.forename: P G
authors.initials: PG
authors.lastname: Davis
mesh_terms: D045422:Continuous Positive Airway Pressure; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007385:Intermittent Positive-Pressure Ventilation / Q000295:instrumentation / Q000379:methods*; D013990:Tidal Volume
keywords: Neonatology; Respiratory