The influence of inspiratory time on the efficiency of non-invasive ventilation in preterm infants

• Oleg V. Ionov
• Kosinova Tatiana A.
• Anna R. Kirtbaya
• Ekaterina N. Balashova
• Victor V. Zubkov
• Baybarina Elena N.

Abstract

It remains unclear whether non-invasive ventilation is more effective than nasal CPAP in premature infants. Short inspiratory time can lead to ineffectiveness of non-invasive ventilation when device with open exhalation circuit such as Infant Flow SiPAP is used in BiPhasic mode. Optimal inspiratory time could compensate circuit leakage and improve the efficiency of non-invasive ventilation.

Aim - to compare three modes of non-invasive respiratory support of Infant Flow SiPAP to define whether inspiratory time influences on the efficiency of non-invasive ventilation in preterm infants.

Material and methods. Prospective comparative trial. 298 premature babies born at 28-35 weeks were included. After initial stabilization on CPAP in delivery room, they were randomized immediately after admission to NICU and divided into 3 groups. 97 newborns formed 1^st group where BiPhasic mode with insp.time 1.0 sec and frequency 30 per minute. 86 newborns formed 2^nd group BiPhasic mode with insp. time 0.5 second and frequency 60 per minute. Group 3 included 115 premature babies on CPAP mode. Mean airway pressure was similar on BiPhasic groups (1^st and 2^nd). Incidents of non-invasive support failure in groups was evaluated. The failure criteria were the increase of FiO₂ >0.4 (FiO₂ >0.3 for babies <1000 g) and/or increasing of severe respiratory distress, hard work of breathing equivalent to 4 and more points by Silverman scale. In case of start respiratory support, failure babies were switched to higher level of respiratory support.

Results. In 1^st group, where the respiratory therapy was provided by BiPhasic mode with Tin of 1.0 second, the failure was 2 times less than in 2^nd group and 3^rd group: 33% vs 65% vs 62% (p=0.00003). Respiratory support failures in 2^nd and 3^rdgroup were similar.

Conclusion. Infant Flow SiPAP on BiPhasic mode has advantage over CPAP when inspiratory time is 1.0 second to compensate the leakage and create an optimal peak inspiratory pressure. BiPhasic mode with inspiratory time 0.5 sec has the same efficiency as CPAP mode and has no advantages over CPAP.

Keywords:CPAP, BiPhasic, Infant flow, Bi-level CPAP, premature infants

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