Related Experiment Videos
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. pgd@unimelb.edu.au
Insights
Nasal continuous positive airway pressure (NCPAP) helps preterm infants avoid respiratory failure after extubation. This reduces the need for further ventilatory support, improving outcomes for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Critical Care Medicine
Background:
- Preterm infants extubated after mechanical ventilation face risks of respiratory failure, including apnea, acidosis, and hypoxia.
- Nasal continuous positive airway pressure (NCPAP) shows potential to stabilize the upper airway and improve lung function in these infants.
Purpose of the Study:
- To determine 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 and meta-analysis of randomized or quasi-random trials comparing NCPAP with headbox oxygen for post-extubation care in preterm infants.
- Searches included major databases (MEDLINE, Cochrane) up to November 2002.
- Data analysis involved relative risk (RR), risk difference (RD), and number needed to treat (NNT).
Main Results:
- NCPAP significantly reduces the incidence of adverse clinical events (apnea, respiratory acidosis, increased oxygen needs) requiring additional ventilatory support post-extubation.
- The relative risk for adverse events was 0.62 (0.49, 0.77), with a risk difference of -0.17 (-0.24, -0.10).
- The number needed to treat with NCPAP to prevent one instance of additional ventilatory support was 6 (4, 10).
Conclusions:
- NCPAP is effective in preventing extubation failure in preterm infants following endotracheal intubation and intermittent positive pressure ventilation (IPPV).
- Further research is needed to define optimal gestational age and weight groups for NCPAP use.
- Optimal NCPAP levels and administration methods require further determination.
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 up to November 2002, Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2002), previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants and journal handsearching mainly in the English language.
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. Data were analysed using relative risk (RR), risk difference (RD) and number needed to treat (NNT).
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 [RR 0.62 (0.49, 0.77), RD -0.17 (-0.24,-0.10), NNT 6 (4,10)].
Implications For Practice:
nasal CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV. Implication for research: further definition of the 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.