Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome

Lampland, Andrea; Plumm, Brenda; Worwa, Cathy; Meyers, Pat A.; Mammel, Mark C.

doi:10.1136/fetalneonatal-2013-305665

Cited by 22 publications

(18 citation statements)

References 21 publications

(11 reference statements)

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“…Nineteen of them had previous intubation and mechanical ventilation and were at an average 33 days of age. The authors compared CPAP and BiPAP in the same patient for a period of one hour and found that BiPAP didn´t improve removal of CO 2 , oxygenation and other physiological parameters [15]. Non-invasive ventilation has also being used for moderate RDS.…”

Section: Discussionmentioning

confidence: 99%

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

Aguiar¹,

Macedo²,

Voutsen³

et al. 2015

J Clin Trials

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Objective: We designed a study with a primary objective of comparing the effectiveness of nasal continuous positive airway pressure (nCPAP) versus bi-level CPAP (BiPAP) as the primary mode of non-invasive ventilation in preterm newborns. The primary outcome was need for invasive ventilation in the first 120 hours of life. The secondary objective was to compare these two groups regarding duration of non-invasive ventilation, use of surfactant, incidence of pneumothorax, bronchopulmonary dysplasia (BPD), peri and intraventricular haemorrhage (PIVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis, length of hospitalisation and mortality.Methods: Prospective, multicentre clinical trial enrolling 220 neonates born at 27 to 32+6 weeks of gestation randomly assigned at birth for either CPAP or BiPAP. Results:One hundred and nine neonates received NCPAP and 111 BiPAP. Invasive ventilation was needed in 18.3% in the CPAP group and 14.4% in the BiPAP group. This difference was not statistically significant. However, when stratifying the groups regarding gestational age (GA), we found a tendency favouring BiPAP in subgroup of 30 to 32+6 weeks. There was no difference regarding the secondary outcomes, except for an increase in NEC in the CPAP group. Multivariate analysis demonstrated a significant association between absence of premature rupture of membranes and the need of invasive ventilation within the first 120 hours of life, independently on the assigned mode of non invasive ventilation. Conclusion:BiPAP and CPAP are both effective and safe as a primary mode of ventilation in preterms between 27 and 32+6 weeks without important complications. In a subgroup of 30 to 32+6 weeks of gestation a better outcome using BiPAP was observed.

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Section: Discussionmentioning

confidence: 99%

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

Aguiar¹,

Macedo²,

Voutsen³

et al. 2015

J Clin Trials

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“…These are typically delivered through CPAP flow driver devices and generate low PIP of about 9–11 cm H 2 O generally using fairly low rates of around 20 and long inspiratory times of about 0.8 s. Although popular, there is no evidence that BIPAP confers any advantage over CPAP, and any clinical differences may simply reflect a higher overall mean airway pressure [97]. Modern ventilators with flow and pressure sensors also provide nasal intermittent positive pressure ventilation, or NIPPV, using pressures similar to those used for invasive MV.…”

Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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“…It is unclear whether these equate to changes in tidal volume or simply an overall increase in the CPAP level. Although increasingly popular, there is not much evidence that it confers any significant advantage over CPAP [84,85]. …”

Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome

Cited by 22 publications

References 21 publications

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

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

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

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