6. Assisted continuous positive airway
pressure (CPAP): nasal intermittent positive
pressure ventilation (NIPPV)
This is a type of respiratory support where the CPAP is combined
with intermittent positive pressure breaths delivered by
the ventilator through the same interface. Presently most
people use intermittent positive pressure ventilation (IPPV)
which is not synchronized with infant’s spontaneous
breathing. However, almost 1/4th of the spontaneous breaths
have been shown to be synchronized with mechanical breaths
by increasing tidal volume.25 The technology to synchronize
NIPPV is being developed and some early experiences have
shown to reduce spontaneous breathing effort.26 NIPPV has
been used to treat RDS in preterm neonates. However, most
studies have compared NIPPV and nCPAP and have reported
reduced need for mechanical ventilation, chronic lung disease.
27,28 However, more data is required to show definite
benefits of this strategy.29,30 NIPPV has also been used along
with INSURE strategy and after extubation with benefits of