178 Use of non-invasive positive pressure triggered ventilation-a bridge between conventional ventilation and CPAP. One centre’s experience

• Published in: Archives of disease in childhood 2023-07, Vol.108 (Suppl 2), p.A136-A136
• Main Authors: Ruth, Nicola, Pervez, SherShah, Heaver, Richard, Babu Kumararatne
• Format: Article
• Language: English
• Subjects: Attrition (Research Studies); Continuous positive airway pressure; Gestation; Mechanical ventilation; Mortality; Outcome Measures; Patients; Pediatrics; Pneumothorax; Pregnancy; Steroid hormones; Ventilation; Weight
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.225

ObjectivesUse of NIPPVTr as a new ventilatory modality was commenced in 2020Designed to be used as a step down to CPAP following extubation and also as a rescue form of ventilation prior to re-ventilationMethodsCohort: Babies born at 23–32 weeks gestation and admitted to a tertiary NICUStudy period: September 2020– 2021Inclusion criteria: inborn infantsData collected included demographics, antenatal and postnatal management including complications.Results113 patients identified as meeting gestation requirement for inclusion86 fitted inclusion criteria46.5% Babies receiving NIPPVTr at any point (n=41)NIPPVTr parameters n=41Median weight when starting NIPPVTr = 895g (range 555 – 1390g)Median Max PIP 18 (range 11 – 27)Had steroids whilst on NIPPVTr = 6/41 patientsFailed NIPPVTr (defined as requiring escalation of respiratory support) = 16/41At gestations up to an including 27/40, babies received NIPPVTr in preference to other modalitiesFrom 28/40 and above this trend was reversedBabies from both the NIPPVTr and non-NIPPVTr cohorts were equally matched for gender and ethnicityBabies who received NIPPVTr had a significantly lower median weight compared to those who did notThe range of weights between both groups was equivalentThe majority of babies did receive surfactant in the first 4h following deliveryIntestinal perforation occurred in 9% of patients overall, with an even split between those receiving NIPPVTr versus those who did notBarotrauma (pneumothorax) was exclusive to those who were not receiving NIPPVTr2/3 of all patients at these gestations were discharged home on home oxygen regardless of ventilatory modalityAll secondary outcome measures (except death) were significantly more likely in the group who did not have NIPPVTr (p