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Nasal Intermittent Positive-Pressure Ventilation Offers No Advantages Over Nasal Continuous Positive Airway Pressure in Apnea of Prematurity

Nasal Intermittent Positive-Pressure Ventilation Offers No Advantages Over Nasal Continuous... Abstract • A prospective, randomized, crossover trial was performed to compare the efficacy of nasal intermittent positive-pressure ventilation with nasal continuous positive airway pressure in infants of less than 32 weeks of gestation. Continuous positive airway pressure was delivered at end-expiratory pressures of 4 cm H2O, while peak pressures of 20 cm H2O and end-expiratory pressures of 4 cm H2O were used during nasal intermittent positive-pressure ventilation at ventilatory rates of 20 breaths per minute. The frequency and extent of apnea and bradycardia during a 6-hour period in a patient receiving nasal continuous positive airway pressure were compared with a similar crossover period of nasal intermittent positive-pressure ventilation. Although the infants had slightly less frequent episodes of apnea per hour (0.6 ±0.7 vs 0.5 ±0.7) and bradycardia per hour (1.2 ±1.3 vs 0.9 ±1.0) during nasal intermittent positive-pressure ventilation, these differences were not significant. There were no significant differences in the severity of these events as assessed by the duration and fall in transcutaneous oxygen pressure during apnea and heart rate during bradycardia. There were no significant changes in blood gases throughout the study. Nasal intermittent positive-pressure ventilation appears to have no advantages over nasal continuous positive airway pressure in preventing apnea and does not alter gas exchange in infants of less than 32 weeks of gestation. (AJDC. 1989;143:1196-1198) References 1. Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure . N Engl J Med . 1971;284:1333-1340.Crossref 2. Rhodes PG, Hall RT. Continuous positive airway pressure delivered by face mask in infants with idiopathic respiratory distress syndrome: a controlled study . Pediatrics . 1973;52:17-21. 3. Baum JD, Robertson NR. Distending pressure in infants with respiratory distress syndrome . Arch Dis Child . 1974;49:771-781.Crossref 4. Spiedel BD, Dunn PM. Use of nasal continuous positive airway pressure to treat severe recurrent apnea in very preterm infants . Lancet . 1976;2:658-660.Crossref 5. Miller MJ, Carlo WA, Martin RJ. Continuous positive airway pressure selectively reduces obstructive apnea in preterm infants . J Pediatr . 1985;106:91-94.Crossref 6. Engelke SC, Roloff DW, Kuhns LR. Postextubation nasal continuous positive airway pressure: a prospective controlled study . AJDC . 1982;136: 359-361. 7. Shapiro BA, Harrison RA, Walton JR. Clinical Application of Blood Gases . 3rd ed. Chicago, Ill: Year Book Medical Publishers Inc; 1982:153. 8. Muttitt SC, Tierney AJ, Finer NN. The dose response of theophylline in the treatment of apnea of prematurity . J Pediatr . 1988;112:115-121.Crossref 9. Machin D, Campbell MJ. Statistical tables for the design of clinical trials . Boston, Mass: Blackwell Scientific Publications Inc; 1987:83-88. 10. Garland JS, Nelson DB, Rice T, Neu J. Increased risk of gastrointestinal perforations in neonates mechanically ventilated with either face mask or nasal prongs . Pediatrics . 1985;76:406-410. 11. Hagan R, Bryan AC, Bryan MH, Gulston G. Neonatal chest wall afferents and regulation of respiration . J Appl Physiol . 1977;42:362-367. 12. Durand M, McCann E, Brady JP. Effect of continuous positive airway pressure on the ventilatory response to CO2 in preterm infants . J Pediatr . 1983;71:634-638. 13. Martin RJ, Nearman HS, Katona PG, Klaus MH. The effect of a low continuous positive airway pressure on the reflex control of respiration in the preterm infant . J Pediatr . 1977;90:976-981.Crossref 14. Abbey NC, Cooper KR, Kwentus JA. Benefit of nasal CPAP in sleep apnea is due to positive pharyngeal pressure and not increased lung volume . Am Rev Respir Dis . 1987;135:135A. 15. Chilton HW, Brooks JG. Pharyngeal pressures in nasal CPAP . J Pediatr . 1979;94:808-810.Crossref 16. Gauda EB, Miller MJ, Carlo WA, Difiore JM, Johnsen DC, Martin RJ. Genioglossus response to airway occlusion in apneic vs nonapneic infants . Pediatr Res . 1987;22:683-687.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Nasal Intermittent Positive-Pressure Ventilation Offers No Advantages Over Nasal Continuous Positive Airway Pressure in Apnea of Prematurity

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References (16)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1989.02150220094026
Publisher site
See Article on Publisher Site

Abstract

Abstract • A prospective, randomized, crossover trial was performed to compare the efficacy of nasal intermittent positive-pressure ventilation with nasal continuous positive airway pressure in infants of less than 32 weeks of gestation. Continuous positive airway pressure was delivered at end-expiratory pressures of 4 cm H2O, while peak pressures of 20 cm H2O and end-expiratory pressures of 4 cm H2O were used during nasal intermittent positive-pressure ventilation at ventilatory rates of 20 breaths per minute. The frequency and extent of apnea and bradycardia during a 6-hour period in a patient receiving nasal continuous positive airway pressure were compared with a similar crossover period of nasal intermittent positive-pressure ventilation. Although the infants had slightly less frequent episodes of apnea per hour (0.6 ±0.7 vs 0.5 ±0.7) and bradycardia per hour (1.2 ±1.3 vs 0.9 ±1.0) during nasal intermittent positive-pressure ventilation, these differences were not significant. There were no significant differences in the severity of these events as assessed by the duration and fall in transcutaneous oxygen pressure during apnea and heart rate during bradycardia. There were no significant changes in blood gases throughout the study. Nasal intermittent positive-pressure ventilation appears to have no advantages over nasal continuous positive airway pressure in preventing apnea and does not alter gas exchange in infants of less than 32 weeks of gestation. (AJDC. 1989;143:1196-1198) References 1. Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure . N Engl J Med . 1971;284:1333-1340.Crossref 2. Rhodes PG, Hall RT. Continuous positive airway pressure delivered by face mask in infants with idiopathic respiratory distress syndrome: a controlled study . Pediatrics . 1973;52:17-21. 3. Baum JD, Robertson NR. Distending pressure in infants with respiratory distress syndrome . Arch Dis Child . 1974;49:771-781.Crossref 4. Spiedel BD, Dunn PM. Use of nasal continuous positive airway pressure to treat severe recurrent apnea in very preterm infants . Lancet . 1976;2:658-660.Crossref 5. Miller MJ, Carlo WA, Martin RJ. Continuous positive airway pressure selectively reduces obstructive apnea in preterm infants . J Pediatr . 1985;106:91-94.Crossref 6. Engelke SC, Roloff DW, Kuhns LR. Postextubation nasal continuous positive airway pressure: a prospective controlled study . AJDC . 1982;136: 359-361. 7. Shapiro BA, Harrison RA, Walton JR. Clinical Application of Blood Gases . 3rd ed. Chicago, Ill: Year Book Medical Publishers Inc; 1982:153. 8. Muttitt SC, Tierney AJ, Finer NN. The dose response of theophylline in the treatment of apnea of prematurity . J Pediatr . 1988;112:115-121.Crossref 9. Machin D, Campbell MJ. Statistical tables for the design of clinical trials . Boston, Mass: Blackwell Scientific Publications Inc; 1987:83-88. 10. Garland JS, Nelson DB, Rice T, Neu J. Increased risk of gastrointestinal perforations in neonates mechanically ventilated with either face mask or nasal prongs . Pediatrics . 1985;76:406-410. 11. Hagan R, Bryan AC, Bryan MH, Gulston G. Neonatal chest wall afferents and regulation of respiration . J Appl Physiol . 1977;42:362-367. 12. Durand M, McCann E, Brady JP. Effect of continuous positive airway pressure on the ventilatory response to CO2 in preterm infants . J Pediatr . 1983;71:634-638. 13. Martin RJ, Nearman HS, Katona PG, Klaus MH. The effect of a low continuous positive airway pressure on the reflex control of respiration in the preterm infant . J Pediatr . 1977;90:976-981.Crossref 14. Abbey NC, Cooper KR, Kwentus JA. Benefit of nasal CPAP in sleep apnea is due to positive pharyngeal pressure and not increased lung volume . Am Rev Respir Dis . 1987;135:135A. 15. Chilton HW, Brooks JG. Pharyngeal pressures in nasal CPAP . J Pediatr . 1979;94:808-810.Crossref 16. Gauda EB, Miller MJ, Carlo WA, Difiore JM, Johnsen DC, Martin RJ. Genioglossus response to airway occlusion in apneic vs nonapneic infants . Pediatr Res . 1987;22:683-687.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Oct 1, 1989

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