Enhance Neonatal Respiratory Care with NIV+ Software

Neonatal invasive ventilation may result in a number of short and long-term impediments including lung inflammation, lung injury, and chronic lung disease.1–4 Minimizing invasive neonatal ventilations may help avoid these complications.1

As noninvasive ventilation gains popularity domestically, loose-fitting interfaces — such as the nasal cannula prongs — may allow air leakage, which can lead to inaccurate tidal volumes.1 Noninvasive ventilator monitors provide ventilator pressure readings in the circuit, but they don’t represent actual delivered pressure at the cannula opening. By the time airflow reaches the neonate, pressure may have significantly dropped. Without an accurate pressure reading, it may be difficult to maximize respiratory care management for your patients.

There are, however, advances in software technology designed to provide greater insights into not just airway leaks, but pressure delivery. NIV+ software with the Puritan Bennett™ 980 (PB980) ventilator helps provide clinicians additional insights on a neonate’s respiratory experience to better support clinicians.

Impacts of invasive ventilation on NICU patients

For premature neonates suffering from severe respiratory failure associated with respiratory distress syndrome (RDS), the predominate intervention method for decades has been endotracheal intubation (ETT) with invasive ventilation.1  Although this may have served as a standard ventilation intervention practice, studies found invasive ventilation to be disruptive to neonatal patients.1  

Increased stress may occur when an ETT is implemented with a neonate. And during the first few weeks and months of a neonate’s life, the goal is to reduce discomfort and stress, which can happen even with routine care.5–7 When a neonate is intubated with uncuffed tubes — significant patient leaks may occur.8

Related: Read more on managing ventilator support for your neonate patients.

Noninvasive ventilation provides greater respiratory support1

To better manage neonatal respiratory care, it’s essential to provide lung protective ventilation that accurately controls pressure and tidal volume levels, as well as prevents atelectasis or injury.9  Noninvasive ventilation provides this respiratory support and may prevent intubation among neonates from occuring.1 With noninvasive ventilation, there are a number of circuit types including nasal cannula interfaces.

While noninvasive ventilation can help decrease the need for stressful procedures and intubation complications associated with invasive ventilation, interface airway leaks can be problematic. If a greater than 50 percent leak occurs, very minimal pressure is delivered — considered a clinically negligible amount.9 Helping to support the holistic picture of how a neonate’s respiratory care is managed with the PB980 ventilator is the NIV+ software, designed to provide accurate ventilation pressures.

Related: Learn more in this video about how the PB980 ventilator is supporting your most vulnerable NICU patients.

How NIV + software supports enhanced NICU patient monitoring

Engineered to provide even more insight into your most vulnerable patient’s breathing, NIV+ software displays real ventilation pressure at the interface. NIV+ software sends flow through the circuit and interface to characterize resistance and determine interface pressure.

Having insight into actual delivered pressure may support better respiratory management. Consider this example. If a neonate struggles to breathe because of a leak, the clinician can use the NIV+ software provided end inspiratory interface pressure and positive end-expiratory pressure (PEEP) in efforts to stabilize a patient based on real noninvasive circuit pressure readings.

Proprietary to the PB980 ventilator, in combination with the Leak Sync software, patient monitoring is enhanced so clinicians know:

  • When leaks occur
  • The amount of inspiratory pressure delivered

NIV+ software also incorporates a disconnect strategy to help detect when the cannula is no longer connected to the neonate. With NIV+ software on the PB980 ventilator, clinicians can set specific criteria for both the leak and disconnect so that only important alarms sound while nuisance alarms are minimized.

Related: Explore our clinical evidence guide on enhancing neonatal respiratory protection .

1. DiBlasi, RM. Neonatal noninvasive ventilation techniques: do we really need to intubate. Respir Care 2011;56(9):1273–1294.
2. Jobe AH, Kramer BW, Moss TJ, Newnham JP, Ikegami M. Decreased indicators of lung injury with continuous positive expiratory pressure in preterm lambs. Pediatr Res 2002;52(3):387–392.
3. Avery ME, Tooley WH, Keller JB, Hurd SS, Bryan MH, Cotton RB, et al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics 1987;79(1):26–30. 11.
4. Van Marter LJ, Allred EN, Pagano M, Sanocka U, Parad R, Moore M, et al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? Pediatrics 2000; 105(6):1194–1201.
5. De Lima J, Carmo KB. Practical pain management in the neonate. Best Pract Res Clin Anaesthesiol 2010;24(3):291–307.
6. Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D. Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med. 2003;157(11):1058–1064.
7. Bellù R, de Waal KA, Zanini R. Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev. 2008;23;(1):CD004212.
8. Main E, Castle R, Stocks J, James I, Hatch D. The influence of endotracheal tube leak on the assessment of respiratory function in ventilated children. Intensive Care Med. 2001;27(11):1788–1797.
9. Chatburn R. Iyer NP. Evaluation of a nasal cannula in noninvasive ventilation using a lung simulator. Respir Care 2014 0;60(0):1.

About the Author

Gary Milne is the Clinical and Technical Director of Ventilation. He has been with Medtronic for 25 years and has been a clinical lead for much of his career. He holds twelve patents on ventilator design and a bachelor of science in respiratory therapy from Indiana University.

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