Future Noninvasive Ventilation Strategies in Neonates

Abstract

The use of noninvasive ventilation (NIV) has increased over the past decade. Most NICUs use various forms of noninvasive positive pressure ventilation that is influenced by leaks at the interface. This limits the effectiveness of using a flow trigger for synchronous delivery of each breath and the resultant asynchrony contributes to the failure of NIV. Two novel approaches to NIV are now available. Noninvasive neurally adjusted ventilatory assist uses a neural trigger to detect the electrical activation of the diaphragm. Each breath is then proportionally assisted based on the onset, strength, and duration of this electrical signal. It is therefore leak-independent and overcomes the challenges of flow-triggered ventilation. High-frequency nasal ventilation is an extension of bubble continuous positive airway pressure and delivers small tidal volumes at high frequencies that can be adjusted to provide appropriate noninvasive support. The functionality of both these modalities will be discussed, including the clinical evidence available to support their use with NIV.