Randomized trial of continuous positive airways pressure to prevent reventilation in preterm infants.
ABSTRACT A prospective randomized controlled trial was performed comparing the use of a short period (24 hr) of postextubation nasal continuous positive airways pressure (CPAP) with direct extubation into headbox oxygen on the outcome of the need for reintubation within 7 days of initial extubation. Infants at less than 32 weeks of gestation who had received mechanical ventilation in the first 28 postnatal days and were being extubated for the first time were recruited. Ninety-seven babies were entered into the study (48 CPAP and 49 headbox oxygen). Twenty-four (49%) babies in the headbox group were reventilated within a week, compared to 16 (33%) in the CPAP group (P=0.17). By 14 days after initial extubation, 25 babies (51%) in the headbox group and 23 (48%) in the CPAP group required reventilation (P=0.9). There was a trend toward babies in the CPAP group requiring fewer reintubations (median, 2; range, 1-6) compared to those in the headbox group (median, 3; range, 1-7) (P=0.063). There was no significant difference between groups with respect to total number of days of ventilation (headbox median, 4; range, 1-24; CPAP median, 2; range, 1-20). In conclusion, this study showed that a short period of nasal CPAP is not associated with a reduction in reventilation.
Article: CPAP review.[Show abstract] [Hide abstract]
ABSTRACT: Continuous positive airway pressure (CPAP) is widely used in neonatal units both as a primary mode of respiratory support and following extubation from mechanical ventilation. In this review, the evidence for CPAP use particularly in prematurely born infants is considered. Studies comparing methods of CPAP generation have yielded conflicting results, but meta-analysis of randomised trials has demonstrated that delivering CPAP via short nasal prongs is most effective in preventing re-intubation. At present, there is insufficient evidence to establish the safety or efficacy of high flow nasal cannulae for prematurely born infants. Observational studies highlighted that early CPAP use rather than intubation and ventilation was associated with a lower incidence of bronchopulmonary dysplasia (BPD), but this has not been confirmed in three large randomised trials. Meta-analysis of the results of randomised trials has demonstrated that use of CPAP reduces extubation failure, particularly if a CPAP level of 5 cm H2O or more is used. Nasal injury can occur and is related to the length of time CPAP is used; weaning CPAP by pressure rather than by "time-cycling" reduces the weaning time and may reduce BPD. In conclusion, further studies are required to identify the optimum mode of CPAP generation and it is important that prematurely born infants are weaned from CPAP as soon as possible.European Journal of Pediatrics 12/2011; 171(10):1441-8. · 1.91 Impact Factor
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ABSTRACT: The use of mechanical ventilation for the treatment of respiratory distress syndrome (RDS) in low birth weight infants may cause barotrauma, volutrauma, and chronic lung disease. Different continuous positive airway pressure (CPAP) delivery systems exist, each with its own practical and clinical advantages and disadvantages. CPAP can be used as either a primary or an adjunctive respiratory support for RDS. Research demonstrates that CPAP decreases the incidence of respiratory failure after extubation. Clinical trials indicate that the optimal management of neonatal RDS consists of early surfactant treatment followed quickly by extubation and stabilization on CPAP. Early surfactant treatment combined with CPAP reduces the need for mechanical ventilation, compared to later surfactant treatment. Evidence suggests a synergistic effect between early surfactant administration and rapid extubation to nasal CPAP.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG. 07/2006; 11(3):145-52.
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ABSTRACT: A large number of ventilation strategies are now available for the neonate. This review has focused on new information, that is, studies published since 2000 and the implication of their results for current clinical practice. Meta-analysis of randomised trials has demonstrated that assist control and synchronous intermittent mandatory ventilation (SIMV) shortens the duration of ventilation only if started in the recovery rather than the early stage of respiratory disease. A recent randomised trial demonstrated pressure-regulated volume control ventilation may also have no advantages if started early. Weaning by SIMV with pressure support is better (reducing oxygen dependency) than SIMV alone. Meta-analysis of volume-targeted ventilation demonstrated significant reductions in the duration of ventilation and pneumothorax, but the trials were small and of different designs. Volume guarantee may provide more consistent blood gas control. The level of volume targeting appears to be crucial to the success of this technique. Meta-analysis of randomised trials of prophylactic high-frequency oscillation trials has shown a modest reduction in bronchopulmonary dysplasia. Randomised trials have failed to confirm the advantages of nasal continuous positive airway pressure (NCPAP) seen in various non-randomised studies; however, the randomised trials reported to date have been small. Inhaled nitric oxide (NO) does not improve the outcome of prematurely born infants with severe respiratory failure, but early low-dose prolonged iNO appears to have benefits that merit further testing. More randomised trials with long-term outcomes are required to identify the optimal ventilation strategy(ies) for the neonate.European Journal of Pediatrics 11/2007; 166(10):991-6. · 1.91 Impact Factor