Hello fellow RTs and anyone else in the NICU business that can shed some light on this issue...
I work in a 30-bed NICU staffed full-time with at least 1 RT. Our current method of applying CPAP is through a nasopharyngeal tube (NCPAP). I am not unfamiliar with using a back up rate in infants with persistent apnea and bradycardia despite conventional NCPAP. However....... Lately a member of our neonatology staff has been ordering high back-up rates (10-15)and pressures (10-14 cmH2O) for everyone on NCPAP. He has even ordered infants to be extubated from low rate SIMV to same-rate NCPAP. Most of these kids have remained on our standard feeding protocols! I hope that my conerns reagarding the increased risk of NEC here are obvious. I have not been able to find any supportive studies for this practice nor has any member of our respiratory staff received an acceptable explanation from this neonatologist.
I am looking for different attitudes and practice guidelines for using NCPAP this way as well as any reference to valid studies using NCPAP in this way.
I work in a large well known center and we have been doing it for years. We have very little NEC. If you have infant stars place the star sync box on and it like bipap.
Do you only use the Infant Star? We use Drager Babylogs on all our babies and occasionally the Sechrist for CPAP only. Thus we do not provide synchronized NIPPV. I have found a few studies but none that used ETT's as nasopharyngeal tubes. All used nasal prongs or binasal prongs which have a much smaller inner diameter than a #2.5 ETT which is our standard here. All of the studies used synchronized NIPPV via the Infant Star as you suggest. We did have an patient develope radiological NEC after being on NIPPV for two days although its probably impossible to single that out as the cause.
