3: Nasal Intermittent Positive Pressure Ventilation in Newborns: Do the Lungs See what is Delivered to the Nose?
Bibliographic record
Abstract
Nasal intermittent positive pressure ventilation (NIPPV) is increasingly used in newborns in an effort to prevent/treat respiratory failure while minimizing ventilator-induced lung injury. Limited data are available in regards to whether NIPPV effectively supports CO2 elimination, what fraction of set ventilator pressures are delivered to the lungs and the resulting tidal volumes (Tv). To evaluate NIPPV-dependent CO2 clearance and measure delivered pressures and Tv using two commonly employed interfaces. An anatomically appropriate neonatal lung model, with either short bi-nasal prongs (FP; Fisher-Paykel, Quebec, Canada) or a small caliber nasal cannula (RAM; Neotech, California, USA), was tested over a range of clinically relevant NIPPV settings. To evaluate CO2 elimination, a fixed amount of CO2 was infused and the fraction remaining in the lung 100 s post-infusion was measured using a CO2 analyzer. Pressure transmission to the lung and Tv were measured via a pressure transducer and a Pneumotach respectively, at the level of the trachea. Lung CO2 elimination did not occur under continuous positive airway pressure (CPAP) and was directly proportional to the inspiratory pressure during NIPPV. At peak pressures of 22 to 34 cm H2O, CO2 clearance was greater (**P<0.001) with FP as compared with RAM (Figure panel A). Relative to the set ventilator pressure, a substantial dampening effect was documented at the lung level, which was significantly lower with RAM vs. FP (mean [± SD]) 2.8±0.2% vs. 11.9±1.5%; P<0.0001]. As shown in Figure panel B, CO2 elimination was dependent on Tv and effective despite amounting to only a small fraction of physiological Tv [maximum delivered % Tv: FP 15.5% (0.7) vs. RAM 6.1% (1.4), P<0.0001]. NIPPV is capable of CO2 elimination despite substantial reduction in delivered lung pressure but less effective with RAM cannula as compared with FP. CO2 elimination occurs at such small Tv that these data suggest that NIPPV may depend on non-conventional mechanisms of ventilation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".