A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants

Abstract

Objective-To compare the eVectiveness of the Infant Flow Driver (IFD) with single prong nasal continuous positive airway pressure (nCPAP) in preterm neonates aVected by respiratory distress syndrome. Design-Randomised controlled study. Patients-Between September 1997 and March 1999, 36 preterm infants who were eligible for CPAP treatment were randomly selected for either nCPAP or IFD and studied prospectively for changes in oxygen requirement and/or respiratory rate. The requirement for mechanical ventilation, complications of treatment, and eVects on mid-term outcome were also evaluated. Results-Use of the IFD had a significantly beneficial eVect on both oxygen requirement and respiratory rate (p < 0.0001) when compared with nCPAP. Moreover, O 2 requirement and respiratory rate were significantly decreased by four hours (p < 0.001 and p < 0.03 respectively). The probability of remaining supplementary oxygen free over the first 48 hours of treatment was significantly higher in patients treated with the IFD than with nCPAP (p < 0.02). IFD treated patients had a higher success (weaning) rate (94% v 72 %) and shorter duration of treatment (49.3 (31) v 56 (29.7) hours respectively; mean (SD)), although the diVerence was not significant. Conclusions-IFD appears to be a feasible device for managing respiratory distress syndrome in preterm infants, and benefits may be had with regard to oxygen requirement and respiratory rate when compared with nCPAP. The trend towards reduced requirement for mechanical ventilation, shorter clinical recovery time, and shorter duration of treatment requires further evaluation in a multicentre randomised clinical trial. (Arch Dis Child Fetal Neonatal Ed 2001;85:F86-F90)

Early variable-flow nasal continuous positive airway pressure in infants ⩽1000 grams at birth

“…The short-term benefits of the variable-flow NCPAP delivery systems over continuous-flow infant ventilator delivery have been demonstrated in several studies; preterm infants supported for short periods of time with variable-flow NCPAP systems have increases in V T and lung volume and decreases in FiO 2 and both inspiratory and resistive work of breathing when compared to continuous-flow NCPAP delivery. 18,26,27 Although the water seal bubble CPAP system employed in other reports of preferential early NCPAP has theoretical advantages in lung recruitment and differential effects in response to variable lung compliance, 17 varying the degree of oscillation does not alter short-term oxygenation or ventilation in preterm infants. 28 Further, no differential effects on lung mechanics were demonstrated after short-term support of preterm infants with the variable-flow system compared to the water seal bubble system, except for slightly lower respiratory rates and resistive work of breathing during variable-flow NCPAP support.…”

Nasal continuous positive airway pressure from high flow cannula versus Infant Flow for preterm infants

“…4,5 IF-CPAP has been shown to decrease oxygen requirement, improve respiratory effort [6][7][8][9] and prevent extubation failure in preterm infants when compared to traditional nasal prong systems and bubble CPAP. 9,10 However, nasal prong CPAP devices have been shown to damage the nares of infants, causing discomfort and rarely, long-term disfigurement. 11,12 Simple nasal cannula has recently been shown to generate positive end-expiratory pressure (PEEP) in preterm infants if air or oxygen is delivered at a high flow rate (i.e.…”

Nasal Bilevel Versus Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

“…Subsequent studies demonstrated that it contributes to a reduction in the need and dependence of oxygen and respiratory rate as well as the need for mechanical ventilation [1][2].…”