Fact sheet: Understanding neonatal non invasive ventilation
Introduction
Many of the babies admitted to the neonatal unit require some degree of respiratory support at varying levels for a given time period as dictated by individualised assessment of their overall condition. This Fact Sheet, following on from Oxygen therapy by Fallon (2012), offers an overview of current non-invasive ventilation practice in neonatal care focusing on the terms and modes used. The aim is for the reader to understand the range of strategies used to support the neonate's respiratory system in line with the relevant evidence for delivery of best practice for the neonate and family.
Section snippets
Respiratory management in the context of neonatal care
Neonates require ventilator support to augment their own respiratory system when this is unable to provide adequate support and gaseous exchange during respiratory compromise or failure. The aim of any neonatal respiratory support strategy is to achieve adequate gaseous exchange without lung injury: in other words, the goal must be a healthy neonate and child with no resultant chronic lung disease (Bellettato et al., 2011), one of the potential and significant long-term effects of prolonged
Overview of non-invasive respiratory support strategies in the neonatal unit
Explanations of the strategies will now be given according to the above dependency levels from 1 through to 3.
Glossary of modes
CPAP–CPAP is a mode itself on all ventilators as well as support strategy in it's own right known as nCPAP (nasal CPAP). On the Flow driver ©, it can be given with or without ‘apnoea’. If CPAP with apnoea is required, then an abdominal transducer is necessary in order to monitor any apnoeic episode and raise the alarm according to the apnoea time interval which is set by the user. On the older Flow driver module that just delivers one level of CPAP, generally a flow is set to 8 L/min to aim for
Conclusion
Technological advances have resulted in improvements in ventilation strategies that offer a wider range of non-invasive modalities. Knowledge of the terms used in neonatal clinical respiratory practice is valuable since this practice comprises a significant proportion of care given to sick neonates within the neonatal unit. It is not possible to cover within the scope of this paper, the nursing care given to the neonate receiving the above mentioned strategies; this will be the subject of a
References (29)
- et al.
Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation
Semin. Fetal Neonatal. Med.
(2009) Fact sheet oxygen therapy
J. Neonatal Nurs.
(2012)Standards for Hospitals Providing Neonatal Intensive and High Dependency Care
(2010)- et al.
Assisted Ventilation of the Newborn
(2011) Nasal Intermittent Positive Pressure Ventilation in the Newborn: Review of Literature and Evidence-based Guidelines
(2010)Taking Neonatal Non-invasive Ventilation to the Next Level Carefusion
(2012)- et al.
New modes of mechanical ventilation in the preterm newborn: evidence of benefit
Arch. Dis. Child. Fetal Neonatal. Ed.
(2007) - et al.
Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants
Cochrane Database Syst. Rev.
(2003) - et al.
Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation
Cochrane Database Syst. Rev.
(2001) - et al.
Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates
Cochrane Database Syst. Rev.
(2008)