Weaning Premature Infants from Nasal Continuous Positive Airway Pressure – Current Practice and Scientific Evidence

2017 ◽  
Vol 229 (04) ◽  
pp. 229-233 ◽  
Author(s):  
André Kidszun ◽  
Christine Arnold ◽  
Julia Winter ◽  
Catharina Whybra-Trümpler ◽  
Eva Mildenberger
Keyword(s):  
Premature Infants ◽  
Airway Pressure ◽  
Online Survey ◽  
Current Practice ◽  
Positive Airway Pressure ◽  
Scientific Evidence ◽  
Tertiary Care ◽  
Initial Step ◽  
Decision Makers ◽  
The Past

Abstract Objective In the past decade, a number of trials have been conducted to determine the optimal strategy of weaning premature infants from nasal continuous airway pressure (nCPAP). However, a paucity of information exists on how weaning is actually performed in clinical routine. Aim of this study was to investigate the current practice of weaning premature infants from nCPAP in Germany. Methods An online survey was performed in German tertiary care neonatal units. Results All 160 German tertiary care units were contacted. Replies were retrieved from 85/160 (53%) units, of which 83/160 (52%) completed the questionnaire. 66/83 (80%) respondents indicated to wean without the use of formal written policies. In 44/83 (53%) units weaning decisions are made jointly between physicians and nurses, whereas physicians are the sole decision makers in 33/83 (40%) as are nurses in 6/83 (7%) units. Many units use more than one weaning strategy. 81/83 units (98%) gradually reduce nCPAP pressure as the initial step in the weaning process. 9/83 (11%) units stop nCPAP at standard criteria [CICADA (CeasIng nCpap At standarD criteriA) method] and 58/83 (70%) units use a cycling nCPAP on/off strategy. 52/83 (63%) of the responding units use nasal high flow at least at some point during the weaning process, either as a gradual weaning method or during nCPAP breaks. Conclusion Weaning strategies from nCPAP vary widely in German tertiary care neonatal units. It appears that evidence is still insufficient to promote a distinct weaning strategy which in turn highlights the urgent need for further adequately powered clinical trials.

scholarly journals Bi-Level Noninvasive Ventilation in Neonatal Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis

Neonatology ◽  
2021 ◽  
Vol 118 (3) ◽  
pp. 264-273
Author(s):  
Anne Lee Solevåg ◽  
Po-Yin Cheung ◽  
Georg M. Schmölzer
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Premature Infants ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

<b><i>Background:</i></b> Bi-level noninvasive ventilation (NIV) has been used in respiratory distress syndrome (RDS) as primary treatment, post-extubation, and to treat apnea. This review summarizes studies on bi-level NIV in premature infants with RDS. Nonsynchronized nasal intermittent positive pressure ventilation (nsNIPPV) and synchronized NIPPV (SNIPPV) use pressure settings ≥ those used during mechanical ventilation (MV), and biphasic continuous positive airway pressure (BiPAP) use two nasal continuous positive airway pressure (NCPAP) levels ≤4 cm H<sub>2</sub>O apart. <b><i>Methods:</i></b> A systematic review (Medline OVID and Pubmed) and meta-analysis of randomized controlled trials. Primary outcomes were bronchopulmonary dysplasia (BPD) and mortality. Secondary outcomes included NIV failure (intubation) and extubation failure (re-intubation). Data were pooled using a fixed-effects model to calculate the relative risk (RR) with 95% confidence interval (CI) between NIV modes (RevMan v 5.3, Copenhagen, Denmark). <b><i>Results:</i></b> Twenty-four randomized controlled trials that largely did not correct for mean airway pressure (MAP) and used outdated ventilators were included. Compared with NCPAP, both nsNIPPV and SNIPPV resulted in less re-intubation (RR 0.88 with 95% CI (0.80, 0.97) and RR 0.20 (0.10, 0.38), respectively) and BPD (RR 0.69 (0.49, 0.97) and RR 0.51 (0.29, 0.88), respectively). nsNIPPV also resulted in less intubation (RR 0.57 (0.45, 0.73) versus NCPAP, with no difference in mortality. One study showed less intubation in BiPAP versus NCPAP. <b><i>Conclusions:</i></b> Bi-level NIV versus NCPAP may reduce MV and BPD in premature infants with RDS. Studies comparing equivalent MAP utilizing currently available machines are needed.

Clinical characteristics of premature infants who orally feed on continuous positive airway pressure

2019 ◽  
Vol 139 ◽  
pp. 104833
Author(s):  
Mariam Susan LaTuga ◽  
Gina Mittelstaedt ◽  
Jee-Young Moon ◽  
Mimi Kim ◽  
Lindsay Murray-Keane ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Premature Infants ◽  
Airway Pressure ◽  
Clinical Characteristics ◽  
Positive Airway Pressure

scholarly journals P102 Accessing healthcare for sleep problems during the COVID-19 pandemic

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A54-A54
Author(s):  
Y Ng ◽  
E Nguyen ◽  
B Bei ◽  
G Hamilton ◽  
S Rajaratnam ◽  
...  
Keyword(s):  
General Practitioner ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Online Survey ◽  
Positive Airway Pressure ◽  
Sleep Problems ◽  
Sleep Study ◽  
Telephone Consultation ◽  
Positive Experiences ◽  
The Impact

Abstract Introduction As part of a study to assess the impact of the COVID-19 pandemic on the sleep of patients of a multidisciplinary sleep clinic, we surveyed how they accessed healthcare for sleep problems. Methods Patients were invited to complete an online survey in October 2020. Results 74 patients completed the survey (mean age 50.2 years, range 21–83 years, 56.8% female). 26/74 (35%) reported at least one delay in accessing healthcare for sleep problems. In particular, 7/49 (14.3%) had delays seeing a general practitioner whilst 16/43 (37.2%) experienced delays accessing a sleep physician. 7/26 (26.9%) reported delays booking a sleep study and 4/15 (26.7%) had delays hiring continuous positive airway pressure equipment. 11/31 (35.5%) experienced delays seeing a psychologist for sleep problems. 11/74 (14.9%) preferred to wait until they were able to attend the clinic in person. 21/74 (28.4%) had telehealth consultations with a sleep physician and/or psychologist. 19/21 (90.5%) described it easy to participate and 20/21 (95.2%) reported receiving satisfactory care through telehealth consultation. Only 5/21 (23.8%) preferred to attend in-person instead of participating in a telehealth consultation again. 11/74 (14.9%) had telephone consultations with a sleep physician and/or psychologist. 8/11 (72.7%) found it easy to participate and 8/11 (72.7%) reported receiving satisfactory care through telephone consultation. Only 3/11 (27.3%) preferred to attend in-person instead of participating in a telephone consultation again. Discussion During the COVID-19 pandemic, 35% of patients reported delays accessing healthcare for sleep problems. Most patients who participated in telehealth and telephone consultations described positive experiences.

scholarly journals Congenital Hairy Polyp of the Palatopharyngeus Muscle

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Brandon Christianson ◽  
Seckin O. Ulualp ◽  
Korgun Koral ◽  
Dinesh Rakheja ◽  
Ronald Deskin
Keyword(s):  
Soft Palate ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Work Of Breathing ◽  
Tertiary Care ◽  
Pediatric Hospital ◽  
Histological Features ◽  
Hairy Polyp ◽  
The Right ◽  
Superior Pole

Purpose. To describe clinical, radiologic, and histological features of a congenital hairy polyp arising from the palatopharyngeus muscle in a neonate.Methods. Chart of a 2-day-old female referred to a tertiary care pediatric hospital for assessment of intraoral mass was reviewed.Results. The child was born at 32 weeks and an intraoral mass was noted. The patient was transferred to tertiary care children’s hospital on day 2 of life. The child had increased work of breathing at presentation and required continuous positive airway pressure. Physical examination revealed a pedunculated mass which was protruding into the oropharynx from the nasopharynx. MRI of the lesion documented a discrete bilobed mass which filled the posterior nasopharynx. The mass abutted the uvula and soft palate; however, the mass did not appear to be arising from the soft palate. Intraoperative exam showed a mass arising from the right palatopharyngeus muscle in the superior pole region of the tonsil. Histologic examination showed ectodermal and mesodermal derivatives confirming congenital hairy polyp. At 8-month followup, the surgical site was healed with no evidence of recurrent lesion.Conclusions. Congenital hairy polyp, though uncommon, should be considered in the differential diagnosis of oropharyngeal mass in neonates.

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