High CPAP vs. NIPPV in preterm neonates - A physiological cross-over study

Amit Mukerji; Muzafar Gani Abdul Wahab; Abdul Razak; Emily Rempel; Waseemoddin Patel; Tapas Mondal; Jennifer Beck

doi:10.1038/s41372-021-01122-6

High CPAP vs. NIPPV in preterm neonates - A physiological cross-over study

J Perinatol. 2021 Jul;41(7):1690-1696. doi: 10.1038/s41372-021-01122-6. Epub 2021 Jun 5.

Authors

Amit Mukerji¹, Muzafar Gani Abdul Wahab², Abdul Razak^{2

3}, Emily Rempel⁴, Waseemoddin Patel^{2

3}, Tapas Mondal², Jennifer Beck^{5

6

7}

Affiliations

¹ Department of Pediatrics, McMaster University, Hamilton, ON, Canada. mukerji@mcmaster.ca.
² Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
³ King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
⁴ Department of Respiratory Therapy, Hamilton Health Sciences, Hamilton, ON, Canada.
⁵ Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Department of Critical Care, St. Michael's Hospital, Toronto, ON, Canada.
⁶ Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
⁷ Member, Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael's Hospital, Toronto, ON, Canada.

Abstract

Objective: To evaluate the physiological impact of high CPAP (≥9 cmH₂O) vs. NIPPV at equivalent mean airway pressures.

Study design: In this cross-over study, preterm neonates on high CPAP or NIPPV were placed on the alternate mode. After 30 min, left and right ventricular cardiac output and work of breathing indices were assessed, following which patients were placed back on the original mode and a similar procedure ensued.

Results: Fifteen infants with mean (SD) postmenstrual age 32.7 (3.0) weeks, and weight 1569 (564) grams were included. No differences in LVO [320 (63) vs. 331 (86) mL/kg/min, P = 0.46] or RVO [420 (135) vs. 437 (141) mL/kg/min, P = 0.19] were noted during high CPAP vs. NIPPV, along with no differences in work of breathing indices.

Conclusion: High CPAP pressures did not adversely impact cardiac output or work of breathing compared to NIPPV at equivalent mean airway pressure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiac Output
Continuous Positive Airway Pressure
Cross-Over Studies
Humans
Infant
Infant, Newborn
Infant, Premature*
Ventricular Function, Right*