Nouvelle technique de pression positive continue par voie nasale en néonatologie

doi:10.1016/0929-693X(96)86403-7

Archives de Pédiatrie

Volume 3, Issue 5, May 1996, Pages 452-456

https://doi.org/10.1016/0929-693X(96)86403-7 Get rights and content

Résumé

La détresse respiratoire du nouveau-né peut être avantageusement traitée par application d'une pression positive continue (PPC) par voie nasale, qui permet de recruter des alvéoles et de restaurer une capacité résiduelle fonctionnelle.

Population et méthodes.- Une PPC nasale, assurée par l'appareil Infant Flow VS PEP (Electro Medical Equipment) a été appliquée à 42 nouveau-nés entre le 15 juin et le 15 décembre 1994. Le poids de naissance et l'âge gestationnel moyens étaient de 1 511 ± 441 g et de 30.9 ± 2,5 semaines respectivement. Quinze enfants ont bénéficié de ce traitement en postextubation après ventilation artificielle pour maladie des membranes hyalines. Dans les autres 27 cas, il s'agissait d'un traitement de première intention (détresse respiratoire: 20 cas, syndrome apnéique: sept cas).

Résultats.- Trois enfants ont dû être intubés secondairement en raison de la sévérité de la détresse respiratoire (dont un après pneumothorax spontané); quatre enfants ont reçu du surfactant (Curosurf^e, une seule dose) à l'occasion d'une brève intubation (30–45 min). Il n'y a eu aucun échec d'extubation, ni aucune lésion cérébrale. L'encombrement pharyngé et le bullonnement abdominal étaient fréquents.

Conclusion.- L'application précoce d'une PPC nasale permet de réduire les indications de ventilation mécanique. Si la détresse respiratoire est plus grave, il est possible d'administrer du surfactant avec une très courte durée de ventilation artificielle.

Abstract

Background.- Early treatment with nasal continuous positive airway pressure (CPAP) in newborns with respiratory distress syndrome is useful, by recruiting alveoli and restoring the functional residual capacity.

Population and methods.- Nasal CPAP was supplied by the Infant Flow Driver (Electro Medical Equipment). From 15 June 1994 to 15 December 1994, 42 neonates received nasal CPAP. Their mean birthweight and gestational age were 1511 ± 411 g and 30.9 ± 2.5 weeks, respectively. Fifteen infants had been ventilated for hyaline membrane disease and nasal CPAP was applied immediately after extubation. In the other 27 infants, nasal CPAP was given soon after birth (respiratory distress syndrome: 20 neonates: apneic spells: seven neonates).

Results.- Three infants needed subsequent mechanical ventilation because of the severity of the disease (one had spontaneous pneumothorax); four infants received exogenous surfactant (Curosurf®, one single dose) within a brief period of mechanical ventilation (30–45 min). There were no failure of extubation, and no intracranial lesions. Excess of pharyngeal secretion and abdominal distension were common.

Conclusion.- Early treatment with nasal CPAP reduces the need for mechanical ventilation. Furthermore, surfactant therapy required by a moderate to severe disease is possible with a rather short period of artificial ventilation.

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There are more references available in the full text version of this article.

Cited by (9)

Continuous positive airway pressure during neonatal resuscitation
2006, Clinics in Perinatology
Nasal continuous positive airway pressure in preterm infants: Comparison of two low-resistance models
2003, Anales de Pediatria
Comparar la eficacia y seguridad de dos modelos diferentes de presión positiva continua en la vía aérea por vía nasal (CPAP-n) de baja resistencia, en recién nacidos pretérminos.
Estudio prospectivo realizado en cuidados intensivos neonatales del Hospital La Fe durante un año, comparando los sistemas Infant Flow (IF) y Medijet (MJ). Se incluyeron todos los pretérminos que precisaron CPAP-n por distress respiratorio al ingreso (grupo I), postextubación en menores de 1.500 g al nacimiento (grupo II) y syndrome apneico-bradicárdico (grupo III); asignación aleatoria a uno u otro sistema.
Estudiamos 125 pacientes, que recibieron 226 tratamientos; 126 con IF y 110 con MJ. Medias edad gestacional, 29,4 semanas, y peso al nacimiento, 1.340 g.
Eficacia. Grupo I (n _ 73): no hubo diferencias entre los 2 modelos consiguiéndose a las 6 h del inicio de CPAP-n descensos de la fracción inspiratoria de oxígeno (FiO2), presión parcial de dióxido de carbono (pCO2) y esfuerzo respiratorio; necesidad similar de intubación y ventilación (34,6 % IF y 24,1% MJ). Grupo II (n _ 73): porcentaje de reintubación semejante a 48 h (19 % IF y 8% MJ). Grupo III (n _ 80): tras 24 h de CPAP-n desaparecieron las apneas en proporción similar (46 % IF y 58 % MJ); precisaron intubación y ventilación 24 % del IF y 10 % del MJ.
Complicaciones. Escapes aéreos: 6 pacientes (4 IF y 2 MJ). Distensión abdominal grave: similar con ambos sistemas (5 %). Lesión nasal significativa: 5 pacientes (1 IF y 4 MJ).
Los dos sistemas de CPAP-n han sido efectivos y seguros en los supuestos estudiados, sin diferencias significativas en los resultados.
To compare the safety and efficacy of two low expiratory resistance models of nasal continuous positive airway pressure (n-CPAP) in preterm infants.
A 1-year prospective trial was performed in the Neonatal Intensive Care Unit of La Fe Hospital to compare the Infant Flow (IF) and Medijet (MJ) devices. All preterm infants requiring n-CPAP for respiratory distress at birth (group I), infants weighting less than 1500 g requiring postextubation (group II) and those with apnea-bradycardia syndrome (ABS) (group III) were included. The patients were randomly assigned to IF or MJ.
A total of 125 patients received 226 treatments (IF: n _ 126: MJ: n _ 110). The mean gestational age was 29.4 weeks and the mean birth weight was 1340 g.
Efficacy. In group I (n 73) no difference were found between systems and 6 hours' after initiation of n-CPAP decreases in FiO2, CO2 and respiratory effort were similar. The need for intubation was also similar (IF: 34.6 %; MJ: 24.1%). In group II (n 73) the need for reintubation at 48 hours was similar with both treatments (IF:19 %; MJ: 8%). In group III (n 80) resolution of ABS was similar after 24 hours of n-CPAP (IF: 46 %; MJ: 58 %). The need for intubation was also similar (IF: 26 %; MJ: 10 %).
Complications. Air leaks occurred in six preterm infants (IF: 4; MJ: 2). Severe abdominal distension occurred in 5% with both systems. Five infants had significant nasal lesions (IF: 1; MJ: 4).
The efficacy and safety of both systems was similar in the variables studied and no significant differences were found.
Non invasive ventilation of premature infants
2002, Archives de Pediatrie
In a retrospective study we evaluated a one year use of nasal continuous positive pressure in our intensive care neonatal unit. One hundred and twelve newborns with a mean gestational age of 30.8 weeks were treated with this technique: 41 were treated early after birth for moderate respiratory; 71 were treated later, either following extubation and assisted ventilation, or as treatment of apnoeas. The main adverse effects were bowel gaseous distension and delayed oral nutrition. Nasal continuous positive airway pressure reduced the duration of intubation and assisted ventilation and could be used more frequently as early first line treatment in respiratory distress.
Physiopathologic evidences for early use of CPAP and exogenous surfactant in hyaline membrane disease
1999, Archives de Pediatrie
L'utilisation de la pression positive continue nasale dans la prise en charge de la maladie des membranes hyalines date du début des années 1970. Les auteurs soulignent les arguments physiopathologiques en faveur d'une application très précoce (dès la salle de naissance) de cette technique chez le grand prématuré. Cette indication prophylactique s'inscrit dans une stratégie de prévention du ≪ dérecrutement ≫ alvéolaire. L'association à l'instillation curative très précoce de surfactant en découle. L'objectif de cette stratégie est de réduire l'incidence et la gravité de la maladie des membranes hyalines. Il pourrait également en résulter un effet protecteur vis-à-vis de la survenue de la dysplasie bronchopulmonaire.
The use of nasal CPAP in the treatment of respiratory distress syndrome in very premature newborns follows pathophysiological basis. The authors emphasize the usefulness of nasal CPAP and surfactant in the treatment of respiratory distress syndrome. The aim of this strategy is to reduce alveolar atelectasis, thus reducing the incidence and the severity of respiratory distress syndrome, together with a possible reduction of the incidence of bronchopulmonary dysplasia.
Comparison of two different CPAP systems by tidal breathing parameters
2003, Intensive Care Medicine
A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants
2001, Archives of Disease in Childhood: Fetal and Neonatal Edition

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Mémoire originalNouvelle technique de pression positive continue par voie nasale en néonatologieNasal continuous positive airway pressure in the treatment of neonstal respiratory distress syndrome

Résumé

Abstract

Chest

Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure

N Engl J Med

A device for administration of continuous positive airway pressure by the nasal route

Pediatrics

Is chronic lung disease in low birth weight infants preventable?

Réanimation néonatale et pression positive continue prophylactique

Pédiatrie

A new device for administration of nasal continuous positive airway pressure in the newborn: an experimental study

Crit Care Med

Mémoire original
Nouvelle technique de pression positive continue par voie nasale en néonatologieNasal continuous positive airway pressure in the treatment of neonstal respiratory distress syndrome