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Non-invasive respiratory support in preterm infants traditionally consisted of the application of continuous distending positive pressure at the nose. More recently, the continuous distending pressure has been combined with intermittent positive pressure cycles using conventional ventilators or devices developed specifically for this purpose. One of the common terms used to refer to these modalities is nasal intermittent positive pressure ventilation (NIPPV). These modalities or devices vary depending on the peak pressure of each cycle, how fast it rises, the duration of the cycle and cycling frequency and whether the positive pressure cycle can be synchronised to the spontaneous inspiration. The mechanisms of action, benefits and limitations of the different devices, modalities and/or applied settings have not been fully explored. Three separate studies sought to improve the understanding of some of these modalities of respiratory support.1–3
Bi-level positive airway pressure (BiPAP) has been proposed as a way to provide higher mean airway pressure (MAP) without the possible side effects of a continuously high distending pressure while the infant is able to breathe at both pressure levels. Lampland et al tested the hypothesis that applying BiPAP without increasing MAP would improve gas exchange compared with nasal continuous positive airway pressure (NCPAP). Twenty preterm infants of median gestational age (GA) of 26 weeks and 33 days old were crossed over twice between NCPAP and BiPAP for 1 h each. During BiPAP, positive end-expiratory pressure (PEEP) and peak pressure were adjusted to provide a minimum Δ pressure of 3 cm H2O for 1 s at a rate of 20/min and match the MAP to the NCPAP level of 6 cm H2O. These investigators found arterial oxygen saturation …
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