Yenidoğanlarda Ekstübasyon Sonrası Non-İnvaziv Solunum Desteğinde Kullanılan İki Farklı Nazal Arayüzün Ekstübasyon Başarısına Etkisi

Year 2024, , 266 - 270, 29.08.2024

Mehmet Fatih Deveci , İsmail Kürşad Gökçe

https://doi.org/10.35440/hutfd.1452759

Abstract

Amaç: Yenidoğanlarda ekstübasyon sonrası non-invaziv ventilasyon desteği sıklıkla kullanılmaktadır. Non-invaziv ventilasyon desteğinin etkinliği, kullanılan nazal arayüzün tipiyle ilişkilidir. Çalışmamızda nazal arayüz tipinin ekstübasyon başarısına etkisini araştırmayı amaçladık.
Materyal ve Metod: Non-invaziv ventilasyona ekstübe edilen toplam 105 term ve preterm hastayı retrospektif olarak değerlendirdik. Hastaları, kullanılan nazal arayüz tipine gore; RAM kanül veya kısa binazal prong (KBP) olarak iki gruba ayırdık. İki grup arasındaki ekstübasyon başarısızlığını inceledik.
Bulgular: Hastaların 63'ü RAM kanül grubunda, 42'si KBP grubunda olup hastaların demografik özellikleri benzerdi. Gruplar arasında ekstübasyon başarısızlık oranları açısından istatistiksel olarak anlamlı fark yoktu (RAM; %44.4 vs KBP; %38.1, p=0.518). RAM kanül grubu KBP grubuna gore; daha yüksek başlangıç ortanca pozitif ekspirasyon sonu basınç (positive end expiratory pressure=PEEP) değerine (7.0 ve 6.5 cmH2O, p=0.038; sırasıyla) ve daha düşük ortanca solunum hızına (60 ve 62/dakika, p=0.032; sırasıyla) sahipti.
Sonuç: Kullanımı daha kolay RAM kanülünün seçilmiş hastalarda özellikle PEEP değerinin yaklaşık olarak 1 cmH2O daha yüksek ayarlanmasıyla kullanılabileceğini düşünüyoruz.

Keywords

RAM kanül, kısa binazal prong, nazal arayüz, ekstübasyon başarısı, non-invaziv ventilasyon

The Effect of Two Different Nasal Interfaces Used in Post-Extubation Non-Invasive Respiratory Support on Extubation Success in Newborns

Abstract

Background: Non-invasive ventilation support is frequently used in newborns after extubation. The efficiency of non-invasive ventilation support is associated to type of nasal interface used. We aimed to investigate the effect of nasal interface type in our study on extubation success.
Materials and Methods: We retrospectively evaluated a total of 105 term and preterm patients who were extubated to non-invasive ventilation. We divided the patients into two groups according to nasal interface type: RAM cannula or short binasal prongs (SBPs). We examined extubation failure between the two groups.
Results: While 63 of the patients were in RAM cannula group, 42 of them were in SBPs group, and the demographic characteristics of the patients were similar. There was no statistically significant differen-ce in the extubation failure rates between the groups (RAM; %44.4 vs SBPs; %38.1, p=0.518). The Ram cannula group had a higher beginning median positive end-expiratory pressure value (7.0 vs 6.5 cmH2O, p=0.038; respectively) and a lower median respiratory rate (60 vs 62/minute, p=0.032; res-pectively) than the SBPs group.
Conclusions: We believe that the easy-to-use RAM cannula can be used in selected patients, especially by setting the PEEP value approximately 1 cmH2O higher.

Keywords

RAM cannula, short binazal prongs, nasal interface, extubation success, non-invasive ventilation

References

• 1. Reid DH, Tunstall ME, Mitchell RG. A controlled trial of artificial respiration in the respiratory-distress syndrome of the newborn. Lancet. 1967;1(7489):532-3.
• 2. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al; NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birth we-ight infants. Am J Obstet Gynecol. 2007;196(2):147.e1-8.
• 3. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Rese-arch Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pedi-atrics. 2010;126(3):443-56.
• 4. Henderson-Smart DJ, Davis PG. Prophylactic methylxanthi-nes for endotracheal extubation in preterm infants. Cochrane Database SystRev. 2010;8(12):CD000139.
• 5. Davis PG, Henderson-Smart DJ. Intravenous dexamethaso-ne for extubation of newborn infants. Cochrane Database SystRev. 2001; (4); CD000308.
• 6. Davis PG, Morley CJ, Owen LS. Non-invasive respiratory support of preterm neonates with respiratory distress: con-tinuous positive airway pressure and nasal intermittent po-sitive pressure ventilation. Semin Fetal Neonatal Med. 2009;14(1):14–20.
• 7. Wung JT, Driscoll JM Jr., Epstein RA, Hyman AI. A new device for CPAP by nasal route. Crit Care Med. 1975;3(2):76–8.
• 8. Lemyre B, Davis PG, De Paoli AG, Kirpalani H. Nasal inter-mittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database SystRev. 2017;1(2) :CD003212.
• 9. Ramanathan R. Nasal respiratory support throught hena-res: its time has come. J Perinatol. 2010;30:67-72.
• 10. Ilhan O, Bor M. Randomized trial of mask or prongs for nasal intermittent mandatory ventilation in term infants with transient tachypnea of the newborn. Pediatr Int 2020;62(4):484-91.
• 11. Bailes SA, Firestone KS, Dunn DK, McNinch NL, Brown MF, et al. Evaluating the effect of flow and interface type on pressures delivered with bubble CPAP in a simulated mo-del. RespirCare 2016;61(3):333–9.
• 12. Gokce IK, Kaya H, Ozdemir R. A randomized trial compa-ring the short binasal prong to the RAM cannula for nonin-vasive ventilation support of preterm infants with respira-tory distress syndrome. J Matern Fetal Neonatal Med. 2021;34(12):1868-74.
• 13. Claassen CC, Hillman NH, Brown K, Williams HL, Strand ML. Comparison of Bubble CPAP Devices Using RAM Can-nula for Extubation Failure in Very Low Birth Weight In-fants: Randomized and Cohort Studies. Neonatology. 2019;115(1):28-35.
• 14. Nzegwu NI, Mack T, DellaVentura R, Dunphy L, Koval N, Levit O, et al. Systematic use of the RAM nasal cannula in the Yale-New Haven Children's Hospital Neonatal Intensive Care Unit: a quality improvement project. J Matern Fetal Neonatal Med. 2015;28(6):718-21.
• 15. Ramanathan R, Andaya S, Smeeta S, Cayabyab RG, Garin-go A. Nasal ventilation in preterm infants: a novel means of delivering time-cycled, pressure and flow-limited inter-mittent mandatory ventilation vianasal cannula in newborn infants. Neonatology. 2010;97:395.
• 16. Gupta S, Donn SM. Continuous positive airway pressure: physiology and comparison of devices. Semin FetalNeona-talMed 2016;21(3): 204-11.
• 17. Mukerji A, Belik J. Neonatal nasal intermittent positive pressure ventilation efficacy and lung pressure transmis-sion. J Perinatol. 2015;35(9):716–9.
• 18. Singh N, J McNally M, A Darnall R. Does the RAM Cannula Provide Continuous Positive Airway Pressure as Effectively as the Hudson Prongs in Preterm Neonates? Am J Perina-tol. 2019;36(8):849-54.
• 19. De Paoli AG, Morley CJ, Davis PG, Lau R, Hingeley E. In vitro comparison of nasal continuous positive airway pressure devices for neonates. Arch Dis Child Fetal Neonatal Ed. 2002;87(1):F42–5.
• 20. Sharma D, Murki S, Maram S, Pratap T, Kiran S, Venka-teshwarlu V, et al. Comparison of delivered distending pressures in the oropharynx in preterm infant on bubble CPAP and on three different nasal interfaces. Peidatr Pul-monol. 2020;55(7):1631-9.
• 21. Claassen CC, Teli MI, Williams HL, Hillman NH. Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations. Am J Perinatol.2021;38(11):1167-73.