NIPPV

Nasal Intermittend Positive Pressure Ventilation

  • Controlled respiratory support for neonates
  • Effective support after extubation and during apnea(1,2)
  • Easy to use and adjust
  • Available in the medinCNO®, medinCNO®mini, medin-NC3 devices®

The umbrella term NIPPV includes modes in which -  in addition to CPAP/PEEP - controlled breaths are applied to support the patient. These breaths have a higher pressure level and are not emitted in a synchronized manner. A differentiation is made between the different variants of this form of respiratory support (Owen 2016, Roberts 2013, Davis 2009).

NIPPV (Owen 2016, Roberts 2013) defines itself in this group with short inspiration times (0.3 – 0.5 sec) and breath rates of 10-60 BPM. Ideally, the patient adapts to the NIPPV rate. NIPPV is a time-controlled mode, that is, the breath frequency is first and foremost set via the inspiration time. 

BiLevel

The BiLevel (Owen 2016, Roberts 2013) mode differs from NIPPV in the longer inspiration time (0.5 s – 1 s) and accordingly lower breath rates (10-30 BPM). The objective is to allow the patient to breathe at both pressure levels. As a result of the longer time with higher pressure, the mean airway pressure can be increased. 

1 Mechanical breath
2 Spontaneous breathing on the second, higher pressure level

When is NIPPV used?

The effects and efficacy of NIPPV were investigated in numerous studies (Owen 2016, Roberts 2013, Davis 2009) . The indications are 

  • Apnea-bradycardia syndrome
  • Post extubation
  • Initial treatment of RDS

The medin system

The specialized CPAP devices from medin in connection with the Medijet® nCPAP generator are ideally suited for the use of NIPPV and BiLevel. With basic flow, the patient is provided with the desired CPAP/PEEP. With the aid of a second flow level which is set in addition to the basic flow via an additional electronic flow meter, Medijet generates a higher pressure level.

Since Medijet allows expiration at any point in time, the patient can breathe freely at both pressure levels. Because of this, the medin CPAP devices allow all NIPPV respiratory support options.

  • Basic flow: In L/min; generates the CPAP/PEEP in the Medijet nCPAP generator
  • Push flow: In L/min; generates a second pressure level, PIP, in the Medijet nCPAP generator, in addition to the basic flow
  • Amplitude: In increments of 1 to 10; defines the level of the pressure amplitude via the depth of closure of the high-frequency valve; level 10 = highest amplitude; level 1 = lowest amplitude
  • Frequency: In BPM; number of breaths per minute depending on the inspiration time
  • oxygen supply

References

Owen LS, Manley BJ; Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Fetal Neonatal Med. 2016 Jun;21(3):146-53. doi: 10.1016/j.siny.2016.01.003. Epub 2016 Feb 26. Review.

Roberts CT, Davis PG, Owen LS; Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013?;  Neonatology. 2013;104(3):203-9. doi: 10.1159/000353448. Epub 2013 Aug 28. Review

Davis PG, Morley CJ, Owen LS.; 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 Feb;14(1):14-20. doi: 10.1016/j.siny.2008.08.003. Epub 2008 Oct 4.