Neonatal and pediatric noninvasive ventilation via single nasal tube

Objectives

In clinical practice an attempt was made to provide adequate ventilation by the use of noninvasive intermittent mandatory ventilation (N-IMV) in the cases of apnea of prematurity, infant hypodynamic respiratory insufficiency and bronchopulmonary dysplasia (BPD)-caused respiratory insufficiency. Advantages of N-IMV oppose the risk of stomach distension and regurgitation due to high tension of the pylorus combined with inadequate cardia tension. The aim of the study was the evaluation of the effectiveness of N-IMV via a single nasal tube combined with the prone position to avoid a risk of abdominal distension.

Methods

Sixty-four newborns with extremely low birth weight (ELBW) and very low birth weight (VLBW), and 21 infants (five with hypodynamic respiratory insufficiency, 16 with BPD-caused respiratory insufficiency) treated with N-IMV were examined during 3 years of studies. Patients meeting the following criteria were qualified for the studies: ineffective nasal continuous positive pressure (N-CPAP) combined with intravenous aminophylline loading, recurrent apnea, hypercarbia (PaCO₂ > 60 mmHg in neonate group, PaCO₂ > 70 mmHg in BPD group). N-IMV was applied through single nasal cannula placed at 3.5–5.0 cm, depending on the patient's age. Ventilation was started at the rate of 10 breaths/min (f) with positive inspiration pressures (PIP) of 12 cmH₂O and inspiration time (IT) of 0.35 s (constant) until adequate ventilation was reached, with maximum f = 35 breaths/min, PIP = 17 cmH₂O. Patients were kept in the prone position with the head and upper body parts elevated by 30°.

Results

The mean noninvasive nasal IMV time in the group of newborns with ELBW was 18 days and in the VLBW group was 11 days. The mean ventilation time in the infant group was 39 days. In all but three children the use of nasal intermittent mandatory ventilation resulted in decreased incidence of apnea, normoxemia and normocapnia. In one case intubation was required, probably due to pneumonia, which was correlated to the incidence of regurgitation.

Conclusions

(1) Satisfactory levels of SaO₂ and pCO₂ were achieved without endotracheal tube placement during N-IMV applied via single nasal cannula. (2) Failure and complications risks are low in study conditions.