Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Tidal volume delivery during nasal intermittent positive pressure ventilation: infant cannula vs. nasal continuous positive airway pressure prongs

Journal of Perinatology volume 44, pages 244–249 (2024)Cite this article

Subjects

Abstract

Objective

To measure tidal volume delivery during nasal intermittent positive pressure ventilation with two nasal interfaces: infant cannula and nasal prongs.

Study design

A single-center crossover study of neonates with mild respiratory distress. Fifteen preterm neonates were randomized to initial interface of infant cannula or nasal prongs and monitored on a sequence of pressure settings first on the initial interface, then repeated on the alternate interface. We compared relative tidal volumes between the two interfaces with two-way repeated measures ANOVA during three breath types: synchronized (I), patient effort without ventilator breaths (II), and ventilator breaths without patient effort (III). Clinical trial #NCT04326270.

Results

Type III breaths delivered no significant tidal volume. No significant difference was measured in relative tidal volume delivery between the interfaces when breath types were matched.

Conclusions

Nasal intermittent positive pressure ventilation delivers neither clinically nor statistically significant tidal volume with either infant cannula or nasal prongs.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Bar graph showing mean Vt and standard deviation (SD) categorized by breath type on each pressure setting for the nCPAP and RAM® interfaces.
Fig. 2: Example data tracings.

Similar content being viewed by others

Data availability

The data from the results of this study are available from the corresponding author on reasonable request.

References

  1. Miller JD, Carlo WA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol. 2008;35:273–81, x-xi.

    Article  PubMed  Google Scholar 

  2. The STOP-ROP Multicenter Study Group. Supplemental therapeutic oxygen for prethreshold retinopathy of prematurity (STOP-ROP), a randomized, controlled trial. I: Primary outcomes. Pediatrics. 2000;105:295–310.

    Article  Google Scholar 

  3. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.

    Article  CAS  PubMed  Google Scholar 

  4. Lemyre B, Davis PG, De Paoli AG, Kirpalani H. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev. 2017;2:CD003212.

    PubMed  Google Scholar 

  5. Meneses J, Bhandari V, Alves JG. Nasal intermittent positive-pressure ventilation vs. nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome. Arch Pediatr Adolesc Med. 2012;166:372–6.

    Article  PubMed  Google Scholar 

  6. Rojas-Reyes MX, Lozano JM, Solà I, Soll R Overview of ventilation strategies for the early management of intubated preterm infants. Cochrane Database Syst Rev. 2015, Issue 4. Art. No.: CD011663. https://doi.org/10.1002/14651858.CD011663.

  7. Dumpa V, Northrup V, Bhandari V. Type and timing of ventilation in the first post-natal week is associated with bronchopulmonary dysplasia/death. Am J Perinatol. 2011;28:321–30.

    Article  PubMed  Google Scholar 

  8. Bhandari V, Gavino RG, Nedrelow JH, Pallela P, Salvador A, Ehrenkranz RA, et al. A randomized controlled trial of synchronized nasal intermittent positive pressure ventilation in RDS. J Perinatol. 2007;27:697–703.

    Article  CAS  PubMed  Google Scholar 

  9. Iyer NP, Chatburn R. Evaluation of a nasal cannula in noninvasive ventilation using a lung simulator. Respir Care. 2015;60:508–12.

    Article  PubMed  Google Scholar 

  10. Mukerji A, Belik J. Neonatal nasal intermittent positive pressure ventilation efficacy and lung pressure transmission. J Perinatol. 2015;35:716–9.

    Article  CAS  PubMed  Google Scholar 

  11. Owen LS, Morley CJ, Dawson JA, Davis PG. Effects of non-synchronised nasal intermittent positive pressure ventilation on spontaneous breathing in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2011;96:F422–F428.

    Article  CAS  PubMed  Google Scholar 

  12. Silveira CST, Leonardi KM, Melo AP, Zaia JE, Brunherotti MAA. Response of preterm infants to 2 noninvasive ventilatory support systems: nasal CPAP and nasal intermittent positive-pressure ventilation. Respir Care. 2015;60:1772–6.

    Article  PubMed  Google Scholar 

  13. Kirpalani H, Millar D, Lemyre B, Yoder BA, Chiu A, Roberts RS, et al. A trial comparing noninvasive ventilation strategies in preterm infants. N. Engl J Med. 2013;369:611–20.

    Article  CAS  PubMed  Google Scholar 

  14. Owen LS, Morley CJ, Davis PG. Pressure variation during ventilator generated nasal intermittent positive pressure ventilation in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2010;95:F359–F364.

    Article  CAS  PubMed  Google Scholar 

  15. Matlock DN, Bai S, Weisner MD, Comtois N, Beck J, Sinderby C, et al. Tidal Volume Transmission During Non-Synchronized Nasal Intermittent Positive Pressure Ventilation via RAM® Cannula. J Perinatol. 2019;39:723–9.

    Article  PubMed  Google Scholar 

  16. Robertson NJ, McCarthy LS, Hamilton PA, Moss ALH. Nasal deformities resulting from flow driver continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed. 1996;75:F209–F212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Yong SC, Chen SJ, Boo NY. Incidence of nasal trauma associated with nasal prong versus nasal mask during continuous positive airway pressure treatment in very low birthweight infants: a randomised control study. Arch Dis Child Fetal Neonatal Ed. 2005;90:F480–F483.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fischer C, Bertelle V, Hohlfield J, Guex MF, Diaw CS, Tolsa JF. Nasal trauma due to continuous positive airway pressure in neonates. Arch Dis Child Fetal Neonatal Ed. 2010;95:F447–F451.

    Article  PubMed  Google Scholar 

  19. Sinderby C, Beck J. Neurally adjusted ventilatory assist in non-invasive ventilation. Minerva Anestesiol. 2013;79:915–25.

    CAS  PubMed  Google Scholar 

  20. Ulm LN, Hamvas A, Ferkol TW, Rodriguez OM, Cleveland CM, Linneman LA, et al. Sources of methodological variability in phase angles from respiratory inductance plethysmography in preterm infants. Ann Am Thorac Soc. 2014;11:753–60.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gerdes JS, Sivieri EM, Abbasi S. Factors influencing delivered mean airway pressure during nasal CPAP with the RAM cannula. Pediatr Pulmonol. 2016;51:60–69.

    Article  PubMed  Google Scholar 

  22. Neotech Products. https://www.neotechproducts.com/product/neotech-ram-cannula/#. Accessed April 6, 2018.

  23. Sivieri EM, Gerdes JS, Abbasi S. Effect of HFNC flow rate, cannula size, and nares diameter on generated airway pressures: an in vitro study. Pediatr Pulmonol. 2013;48:506–14.

    Article  PubMed  Google Scholar 

  24. Reddy SP, Fisher S, White DB, Stein H. Pilot study to compare two nasal airway interfaces in neonates on non-invasive neurally adjusted ventilatory assist. Neonatal Intensive Care. 2015;28:40–42.

    Google Scholar 

  25. Bailes SA, Firestone KS, Dunn DK, McNinch NL, Brown MF, Volsko TA. Evaluating the effect of flow and interface type on pressures delivered with bubble CPAP in a simulated model. Respir Care. 2016;61:333–9.

    Article  PubMed  Google Scholar 

  26. Hochwald O, Borenstein-Levin L, Dinur G, Jubran H, Littner Y, Breuer M, et al. The effect of changing respiratory rate settingds on CO2 levels during nasal intermittent positive pressure ventilation (NIPPV) in premature infants. J Perinatol. 2023;43:305–10.

    Article  CAS  PubMed  Google Scholar 

  27. Namdevb S, Tarafdar O, Fusch G, Beck J, Mukerji A. Pressure transmission and electrical diaphragm activity in preterm infants during nasal intermittent positive pressure ventilation – an exploratory prospective physiological study. J Perinatol. 2023;43:1004–6.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Arkansas Children’s Hospital and the University of Arkansas for Medical Sciences for the provision of a supportive environment in which to conduct research. We would also like to thank the nursing and respiratory therapy staff for their willingness to assist with instrumentation and other practical matters when needed. We thank Mr. Norm Comtois for his invaluable assistance with data analysis. Finally, we thank the families who allowed us the privilege of enlisting their babies in our pursual of improved practices in neonatal critical care.

Funding

This research study was funded by a Postdoctoral Fellowship Grant Award from Arkansas Children’s Research Institute.

Author information

Authors and Affiliations

  1. University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Ashley L. Lynch, David N. Matlock & Sherry E. Courtney

  2. Biostatistics Core, Arkansas Children’s Research Institute, Arkansas Children’s Hospital, Little Rock, USA

    Chary Akmyradov

  3. Equilibrated Bio Systems, Inc., Smithtown, NY, USA

    Michael D. Weisner

  4. Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, ON, Canada

    Jennifer Beck & Christer Sinderby

  5. Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Jennifer Beck & Christer Sinderby

  6. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Jennifer Beck

  7. Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael’s Hospital, Toronto, ON, Canada

    Jennifer Beck & Christer Sinderby

Authors
  1. Ashley L. Lynch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David N. Matlock
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chary Akmyradov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael D. Weisner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christer Sinderby
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sherry E. Courtney
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ALL, DNM, MDW, JB, CS, and SEC contributed to the conception and design of this study. ALL, DNM, and SEC consented and enrolled study patients and collected data from the trials. ALL, DNM, BS, MDW, JB, CS, and SEC contributed to data analysis and interpretation. The manuscript was composed by ALL, with critical revisions by DNM, BS, MDW, JB, CS, and SEC.

Corresponding author

Correspondence to Ashley L. Lynch.

Ethics declarations

Competing interests

JB, CS have secured patents for original inventions of technology for neural control of mechanical ventilation. These patents are designated to the academic institutions where the inventions were created, and the license for the patents is owned by Maquet Critical Care®. Commercial use of this technology may result in future financial gain to JB and CS via royalty payments. Neurovent Research Inc.® (NVR) is a research and development company owned by JB and CS which manufactures equipment and catheters for research studies, and there is a consultant contract between NVR and Maquet Critical Care®. ALL, DNM, BS, and SEC have no disclosures.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lynch, A.L., Matlock, D.N., Akmyradov, C. et al. Tidal volume delivery during nasal intermittent positive pressure ventilation: infant cannula vs. nasal continuous positive airway pressure prongs. J Perinatol 44, 244–249 (2024). https://doi.org/10.1038/s41372-023-01846-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-023-01846-7

Search

Advanced search

Quick links