title: Use of high noninvasive respiratory support pressures in preterm neonates: a single-center experience.
abstract: OBJECTIVE
  To describe the incidence, indications and clinical outcomes following high pressures on noninvasive respiratory support (NRS) in preterm neonates.
  
  
  METHODS
  Retrospective cohort study of all neonates with BW <1.500 g admitted from July 2012 to June 2014 and placed on high noninvasive respiratory support (NRS), defined as mean airway pressure ≥10 cm H2O for at least 12 continuous hours using nasal continuous positive airway pressure (NCPAP) and/or nasal high-frequency ventilation (NIHFV). Clinical and physiological outcomes following high NRS were ascertained. Median (IQR) and percentages were used to describe continuous and categorical data, respectively.
  
  
  RESULTS
  There were 131 instances of high NRS use in 70 of 315 eligible infants. Most common indication was post-extubation, observed in 37% (49/131) of high NRS instances. Intubation was avoided in 71% (93/131) of instances in the first 7 days following high NRS initiation. There were no physiological perturbations in heart rate, blood pressure or oxygen requirement. Furthermore, there were no instances of lung hyperinflation, pneumothoraces or spontaneous intestinal perforation following high NRS.
  
  
  CONCLUSIONS
  The use of high NRS pressure was followed by avoidance of intubation in the majority of cases without adverse effects. Further research on high NRS use including its indications, clinical outcomes and safety profile is warranted.
authors.affiliation: a McMaster Children's Hospital , Hamilton , Ontario , Canada.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Binmanee
authors.affiliation: a McMaster Children's Hospital , Hamilton , Ontario , Canada.
authors.forename: Salhab
authors.initials: S
authors.lastname: El Helou
authors.affiliation: a McMaster Children's Hospital , Hamilton , Ontario , Canada.
authors.forename: Sandesh
authors.initials: S
authors.lastname: Shivananda
authors.affiliation: a McMaster Children's Hospital , Hamilton , Ontario , Canada.
authors.forename: Christoph
authors.initials: C
authors.lastname: Fusch
authors.affiliation: a McMaster Children's Hospital , Hamilton , Ontario , Canada.
authors.forename: Amit
authors.initials: A
authors.lastname: Mukerji
mesh_terms: D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000379:methods; D005260:Female; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects / Q000379:methods; D008297:Male; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Nasal CPAP; invasive mechanical ventilation; noninvasive high-frequency ventilation; noninvasive ventilation