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Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants
P G Davis1, D J Henderson-Smart
1Division of Paediatrics, Royal Women's Hospital, 132 Grattan St, Melbourne, Victoria, Australia, 3053. p.davis@obgyn-rwh.unimelb.edu.au
Insights
Nasal continuous positive airway pressure (NCPAP) effectively prevents extubation failure in preterm infants after intermittent positive pressure ventilation (IPPV). This method reduces respiratory support needs and chronic lung disease, improving outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Critical Care
Background:
- Preterm infants extubated after intermittent positive pressure ventilation (IPPV) face risks of respiratory failure, including apnea, acidosis, and hypoxia.
- Nasal continuous positive airway pressure (NCPAP) shows potential to stabilize the upper airway, enhance lung function, and decrease apnea, aiding extubation in this vulnerable group.
Purpose of the Study:
- To evaluate if nasal continuous positive airway pressure (NCPAP) management increases the proportion of preterm infants remaining free of additional ventilatory support post-extubation compared to headbox oxygen.
Main Methods:
- Systematic review of randomized or quasi-random trials comparing NCPAP with headbox oxygen for post-extubation care in preterm infants.
- Independent assessment of methodological quality and data extraction by two authors.
- Subgroup analyses were conducted to examine the impact of NCPAP levels, IPPV duration, and aminophylline use.
Main Results:
- NCPAP significantly reduces the incidence of adverse clinical events (apnea, respiratory acidosis, increased oxygen requirements) post-extubation, indicating a need for less additional ventilatory support.
- A notable reduction in chronic lung disease at 28 days of age was observed in preterm infants managed with NCPAP post-extubation.
Conclusions:
- Nasal CPAP is effective in preventing extubation failure and decreasing oxygen requirements at 28 days in preterm infants following IPPV and endotracheal intubation.
- Further research is needed to define optimal patient groups (gestational age, weight), NCPAP levels, and administration methods for this intervention.
Background:
Preterm infants being extubated following a period of intermittent positive pressure ventilation via an endotracheal tube are at risk of developing respiratory failure as a result of apnea, respiratory acidosis and hypoxia. Nasal continuous positive airway pressure appears to stabilise the upper airway, improve lung function and reduce apnea and may therefore have a role in facilitating extubation in this population.
Objectives:
In preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), does management with nasal continuous positive airways pressure (NCPAP) lead to an increased proportion remaining free of additional ventilatory support, compared to extubation directly to headbox oxygen?
Search Strategy:
Searches were made of the Oxford Database of Perinatal Trials, Medline, previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language and expert informant searches in the Japanese language by Prof. Ogawa.
Selection Criteria:
All trials utilising random or quasi-random patient allocation, in which NCPAP (delivered by any method) was compared with headbox oxygen for post-extubation care were included. Methodological quality was assessed independently by the two authors.
Data Collection And Analysis:
Data were extracted independently by the two authors. Prespecified subgroup analysis to determine the impact of different levels of NCPAP, differences in duration of IPPV and use of aminophylline were also performed using the same package.
Main Results:
Nasal CPAP, when applied to preterm infants being extubated following IPPV, reduces the incidence of adverse clinical events (apnea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support. A reduction in the incidence of chronic lung disease at 28 days of age is also seen in the group extubated to NCPAP.
Implications For Practice:
nasal CPAP is effective in preventing failure of extubation and reducing oxygen use at 28 days of life in preterm infants following a period of endotracheal intubation and IPPV. Implication for research: further definition of the patient gestational age and weight groups in whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.