Myth: mechanical ventilation is a therapeutic relic.

Area of Science:

• Neonatal Medicine
• Pediatric Respiratory Care
• Critical Care

Background:

• Continuous positive airway pressure (CPAP) is a non-invasive respiratory support method increasingly utilized for surfactant-deficient lung disease in preterm infants.
• Successful CPAP application relies on the infant's condition at birth and the establishment of spontaneous respiration.
• While observational studies suggested reduced chronic lung disease, recent randomized trials have not consistently substantiated these benefits.

Purpose of the Study:

• To evaluate the efficacy and application of continuous positive airway pressure (CPAP) in managing respiratory distress in preterm infants.
• To analyze the evidence supporting CPAP's role in reducing chronic lung disease in this population.
• To provide guidance on patient selection for CPAP, particularly in extremely preterm infants.

Main Methods:

• Review of recent well-designed randomized trials comparing CPAP with other respiratory support strategies.
• Analysis of observational studies reporting on CPAP use and outcomes in preterm infants.
• Assessment of criteria for successful CPAP implementation, including infant condition and spontaneous breathing.

Main Results:

• Evidence from recent randomized trials does not consistently support the previously reported advantages of CPAP in reducing chronic lung disease.
• CPAP is more established in larger and more mature preterm infants.
• The effectiveness of CPAP in extremely low gestational age infants requires careful patient selection and close monitoring.

Conclusions:

• The benefits of CPAP for surfactant-deficient lung disease in preterm infants, as suggested by observational data, require further substantiation through rigorous trials.
• Current evidence indicates CPAP is more reliably applied in larger, more mature preterm infants.
• Judicious patient selection and vigilant observation are crucial when considering CPAP for extremely preterm infants due to potential risks and variable efficacy.