- •
Non-invasive support modalities utilize different applications and mechanisms but share similar physiologic mechanisms of support.
- •
All modes assist care givers in avoiding mechanical ventilation and the associated injuries to the lungs and airways.
- •
None of the modalities can achieve the ideal goal of being the right therapy for all patients across the age and disease spectrum treated in the newborn intensive care unit setting.
Physiologic Basis for Nasal Continuous Positive Airway Pressure, Heated and Humidified High-Flow Nasal Cannula, and Nasal Ventilation
Section snippets
Key points
Prevention of Mucosal Injury
A crucial function of noninvasive support modalities is their ability to condition the respiratory gases, by both warming to near body temperature, and humidifying the gas mixtures. Without this proper conditioning, patient discomfort and nasal mucosal injury, as well as pharyngeal and lower airway injury, are well described.
Early in the attempts to provide supplemental support to patients with respiratory distress, it became clear that appropriate conditioning was crucial for maintaining
Summary
All 3 modalities that provide noninvasive support have demonstrated value for clinicians treating both preterm and term infants with a wide variety of pathophysiologies leading to respiratory distress and apnea. Whether the device is a pressure-regulated system using flow to generate pressures delivered at the nasopharynx or simple flow delivery systems to the nasopharynx, the mechanisms leading to improvement are similar across the modalities. The ability to support the inspiratory work of
References (38)
- et al.
Nasal intermittent positive pressure ventilation in preterm infants: equipment, evidence, and synchronization
Semin Fetal Neonatal Med
(2016) - et al.
Airway responsiveness to low inspired gas temperature in preterm neonates
J Pediatr
(1991) - et al.
Continuous positive airway pressure selectively reduces obstructive apnea in preterm infants
J Pediatr
(1985) - et al.
Research in high flow therapy: mechanisms of action
Respir Med
(2009) - et al.
Use of high flow nasal cannula on a pediatric burn patient with inhalation injury and post-extubation stridor
Burns
(2006) - et al.
Effect of low flow and high flow oxygen delivery on exercise tolerance and sensation of dyspnea. A study comparing the transtracheal catheter and nasal prongs
Chest
(1994) - et al.
Targeting inflammation to prevent bronchopulmonary dysplasia: can new insights be translated into therapies?
Pediatrics
(2011) - et al.
High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence
Neonatology
(2012) - et al.
Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure
N Engl J Med
(1971) - et al.
Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants
Cochrane Database Syst Rev
(2003)
Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation
Cochrane Database Syst Rev
Apnea of prematurity: I. Lung function and regulation of breathing
Pediatrics
Pathophysiology of apnea of prematurity
Fetal Neonatal Physiol
Humidification of the air passages
Acta Otolaryngol
Changes in airway resistance induced by nasal inhalation of cold dry, dry, or moist air in normal individuals
J Appl Physiol (1985)
Comparing two methods of delivering high-flow gas therapy by nasal cannula following endotracheal extubation: a prospective, randomized, masked, crossover trial
J Perinatol
Flow-synchronized nasal intermittent positive pressure ventilation for infants <32 weeks’ gestation with respiratory distress syndrome
Crit Care Res Pract
Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: unmasked randomized controlled trial
Pediatr Int
Cited by (0)
Disclosures: None.