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Area of Science:

  • Neonatal respiratory support
  • Mechanical ventilation strategies
  • Postextubation care

Background:

  • Nasal intermittent positive pressure ventilation (NIPPV) is generally considered superior to nasal continuous positive airway pressure (CPAP) for preterm neonates postextubation.
  • Previous studies limited high CPAP pressures or rescue ventilation options, potentially skewing comparisons.
  • This study investigated whether CPAP could be noninferior to NIPPV under conditions allowing higher pressures and rescue ventilation.

Purpose of the Study:

  • To determine if nasal CPAP (nCPAP) is noninferior to NIPPV as a postextubation mode in preterm neonates (<29 weeks' gestation).
  • To evaluate outcomes when higher CPAP pressures and rescue ventilation were permitted.
  • To compare rates of initial mode failure and reintubation between nCPAP and NIPPV.

Main Methods:

  • A pragmatic, comparative-effectiveness, noninferiority study using real-world data from 22 Canadian NICUs.
  • Centers self-selected either nCPAP or NIPPV as their standard postextubation mode.
  • Primary outcome: failure of the initial mode within 72 hours. Secondary outcomes: failure within 7 days, and reintubation within 72 hours and 7 days.

Main Results:

  • Nasal CPAP was not noninferior (and was inferior) to NIPPV for initial mode failure within 72 hours (33.0% vs 26.3%) and within 7 days (40.7% vs 35.8%).
  • However, nasal CPAP was noninferior (and equivalent) to NIPPV for reintubation within 72 hours (13.2% vs 16.1%).
  • Nasal CPAP was also noninferior (and superior) to NIPPV for reintubation within 7 days (16.4% vs 22.8%).

Conclusions:

  • Nasal CPAP was not noninferior to NIPPV for preventing initial mode failure postextubation in preterm neonates.
  • Nasal CPAP demonstrated noninferiority for reintubation rates at both 72 hours and 7 days.
  • Nasal CPAP may be a viable initial postextubation strategy when effective rescue ventilation options are available.