SNIPPV

Synchronized Nasal Intermittend Positive Pressure Ventilation

  • Effective synchronized support
  • MediTRIG technology without an additional sensor
  • Closed-loop apnea treatment
  • Available in the medinCNO device® 

SNIPPV is the synchronized variant of the NIPPV respiratory support. In NIPPV, the breaths are administered by the device independent of the patient’s own breathing. This can lead to conflicts in the synchronization between the patient and the device. In SNIPPV, the breaths are coordinated to the patient’s inspiration and conflicts are minimized.

Studies were not only able to demonstrate the efficacy of SNIPPV. SNIPPV is superior in many indications compared to conventional modes such as nCPAP and NIPPV: (Owen 2016, Roberts 2013, Eun 2016)

  • Apnea-bradycardia syndrome
  • Reintubation rate
  • Reduction in breathing effort

medin trigger system - MediTRIG

The type of trigger system plays an important role. The innovative pressure trigger system MediTRIG detects the patient’s airway pressures and from them, it can identify the start of inspiration. The spontaneous breaths are supported by breaths from the device with additional pressure.

MediTRIG does not require any additional sensor to record the patient’s own breathing, such as in the case of an abdominal capsule. MediTRIG gently detects the necessary signals directly at the nose of the small patient.

The closed-loop apnea functions are available in SNIPPV mode. The SNIPPV and MediTRIG parameters can be individually adapted to the patient.

SNIPPV is defined by inspiration times which are as short as possible (0.2-0.5 sec) and breath rates up to 90/100 BPM. SNIPPV is a time-controlled mode, that is, the breath frequency is first and foremost set via the inspiration time and an expiration pause. In the expiration pause, the patient breathes on the CPAP level and the device does not emit any supportive breaths. In this way, the support can be individually adapted to the patient's needs. The level of pressure support is individually coordinated to the patient's needs with the aid of a second flow level. 

The following parameters are to be set

  • 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
  • Inspiration time: From 0.2 s to 2 s; duration of breath
  • Expiration pause: In sec.; time window during which no breaths are emitted to the patient
  • Sensitivity trigger: +/- mbar; upper and lower trigger threshold as pressure difference with regard to the PEEP;
  • Apnea time: From 2 s to 20 s; duration of breathing pause until device reacts
  • Inspiration time: From 0.2 s to 2 s; duration of breath
  • Push flow: Additional adjustable breathing gas flow with which a peak pressure can be generated
  • Backup rate: number of automatic breaths per minute which are administered to the patient after the end of apnea time
  • Oxygen supply 
  1. Trigger breath
  2. Push/breath
  3. Pause expiration
  4. Trigger breath
  5. Apnea

References

Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Semin 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

Eun Mi Choi, M.D., Jae Hyun Park, M.D., Chun Soo Kim, M.D., and Sang Lak Lee, M.D. Pulmonary Outcomes of Early Extubation in Extremely Premature Infants (Gestational Age: 25–26 Weeks) with Synchronized Nasal Intermittent Positive-Pressure Ventilation Neonatal Med 2016 May;23(2):81-87, http://dx.doi.org/10.5385/nm.2016.23.2.81pISSN 2287-9412 . eISSN 2287-9803