Related Experiment Videos
Continuous distending airway pressure for respiratory distress syndrome in preterm infants
J J Ho1, P Subramaniam, D J Henderson-Smart
1Paediatrics, Perak College of Medicine, Jalan Greeentown, Ipoh, Malaysia. jackie@perakmed.edu.my
Insights
Continuous distending airway pressure (CDAP) reduces mortality and the need for mechanical ventilation in preterm infants with respiratory distress syndrome (RDS). However, CDAP use is linked to a higher incidence of pneumothorax.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Respiratory distress syndrome (RDS) is a primary cause of death and illness in preterm infants.
- Intermittent positive pressure ventilation (IPPV) is standard but invasive, causing lung injury.
- Chronic lung disease can develop from IPPV-related airway and lung injury.
Purpose of the Study:
- To evaluate if continuous distending airway pressure (CDAP) decreases IPPV use and related complications in spontaneously breathing preterm infants with RDS.
- To assess potential adverse effects of CDAP in this population.
Main Methods:
- Systematic review of randomized and quasi-random trials involving newborn infants with RDS.
- Interventions included continuous positive airway pressure (CPAP) or continuous negative pressure (CNDP) via various methods.
- Compared CDAP with standard care, with independent quality assessment and data extraction.
Main Results:
- CDAP use was associated with reduced treatment failure rates (death or need for assisted ventilation).
- Overall mortality and mortality in infants >1500g birthweight were lower with CDAP.
- An increased rate of pneumothorax was observed with CDAP use.
Conclusions:
- CDAP (CPAP or CNDP) offers benefits for preterm infants with RDS, especially those >1500g birthweight.
- The full benefit is hard to gauge due to historical trial limitations (outdated methods, limited surfactant, antenatal steroid use).
- CPAP may be valuable in resource-limited settings; further research is needed for modern intensive care applications.
Background:
Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm infants (Greenough 1998, Bancalari 1992). Intermittent positive pressure ventilation (IPPV) with surfactant is the standard treatment for the condition. The major difficulty with IPPV is that it is invasive, resulting in airway and lung injury and contributing to the development of chronic lung disease.
Objectives:
In spontaneously breathing preterm infants with RDS, to determine if continuous distending airway pressure (CDAP) reduces the need for IPPV and associated morbidity without adverse effects.
Search Strategy:
The standard search strategy of the Neonatal Review group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, journal hand searching mainly in the English language.
Selection Criteria:
All trials using random or quasi-random patient allocation of newborn infants with RDS were eligible. Interventions were continuous distending airway pressure including continuous positive airway pressure (CPAP) by mask, nasal prong, nasopharnygeal tube, or endotracheal tube, or continuous negative pressure (CNDP) via a chamber enclosing the thorax and lower body, compared with standard care.
Data Collection And Analysis:
Standard methods of the Cochrane Collaboration and its Neonatal Review Group, including independent assessment of trial quality and extraction of data by each author, were used.
Main Results:
CDAP is associated with a lower rate of failed treatment (death or use of assisted ventilation), overall mortality, and mortality in infants with birthweights above 1500 g. The use of CDAP is associated with an increased rate of pneumothorax.
Reviewer'S Conclusions:
In preterm infants with RDS the application of CDAP either as CPAP or CNDP is associated with some benefits, particularly in infants with birthweights over 1500 gms. The extent of this benefit is difficult to assess given the outdated methods to administer CDAP, low use of antenatal corticosteroids, non-availability of surfactant and the intensive care setting of the 1970's in which these trials were done. Where resources are limited, such as in developing countries, CPAP for RDS may have a clinical role. Further research is required to determine the best mode of administration and its role in modern intensive care settings