title: Synchronized Nasal Intermittent Positive Pressure Ventilation of the Newborn: Technical Issues and Clinical Results.
abstract: Although mechanical ventilation via an endotracheal tube has undoubtedly led to improvement in neonatal survival in the last 40 years, the prolonged use of this technique may predispose the infant to development of many possible complications including bronchopulmonary dysplasia. Avoiding mechanical ventilation is thought to be a critical goal, and different modes of noninvasive respiratory support beyond nasal continuous positive airway pressure, such as nasal intermittent positive pressure ventilation and synchronized nasal intermittent positive pressure ventilation, are also available and may reduce intubation rate. Several trials have demonstrated that the newer modes of noninvasive ventilation are more effective than nasal continuous positive airway pressure in reducing extubation failure and may also be more helpful as modes of primary support to treat respiratory distress syndrome after surfactant and for treatment of apnea of prematurity. With synchronized noninvasive ventilation, these benefits are more consistent, and different modes of synchronization have been reported. Although flow-triggering is the most common mode of synchronization, this technique is not reliable for noninvasive ventilation in neonates because it is affected by variable leaks at the mouth and nose. This review discusses the mechanisms of action, benefits and limitations of noninvasive ventilation, describes the different modes of synchronization and analyzes the technical characteristics, properties and clinical results of a flow-sensor expressly developed for synchronized noninvasive ventilation.
authors.affiliation: Pediatric Emergency and Intensive Care, Department of Pediatrics, Policlinico x2018;Umberto I', Sapienza University of Rome, Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Moretti
authors.forename: Camilla
authors.initials: C
authors.lastname: Gizzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Montecchia
authors.forename: Caterina Silvia
authors.initials: CS
authors.lastname: Barbàra
authors.forename: Fabio
authors.initials: F
authors.lastname: Midulla
authors.forename: Manuel
authors.initials: M
authors.lastname: Sanchez-Luna
authors.forename: Paola
authors.initials: P
authors.lastname: Papoff
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects; D001049:Apnea / Q000628:therapy*; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure / Q000379:methods; D004867:Equipment Design; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007385:Intermittent Positive-Pressure Ventilation / Q000295:instrumentation / Q000379:methods*; D007442:Intubation, Intratracheal / Q000009:adverse effects; D063087:Noninvasive Ventilation / Q000379:methods; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*
chemical_list: D011663:Pulmonary Surfactants