Bubble CPAP versus CPAP with variable flow in newborns with respiratory distress: a randomized controlled trial

Abstract

Objective: To evaluate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) using devices with variable flow or bubble continuous positive airway pressure (CPAP) regarding CPAP failure, presence of air leaks, total CPAP and oxygen time, and length of intensive care unit and hospital stay in neonates with moderate respiratory distress (RD) and birth weight (BW) ≥ 1,500 g. Methods:Forty newborns requiring NCPAP were randomized into two study groups: variable flow group (VF) and continuous flow group (CF). The study was conducted between October 2008 and April 2010. Demographic data, CPAP failure, presence of air leaks, and total CPAP and oxygen time were recorded. Categorical outcomes were tested using the chi-square test or the Fisher's exact test. Continuous variables were analyzed using the Mann-Whitney test. The level of significance was set at p < 0.05. Results:There were no differences between the groups with regard to demographic data, CPAP failure (21.1 and 20.0% for VF and CF, respectively; p = 1.000), air leak syndrome (10.5 and 5.0%, respectively; p = 0.605), total CPAP time (median: 22.0 h, interquartile range [IQR]: 8.00-31.00 h and median: 22.0 h, IQR: 6.00-32.00 h, respectively; p = 0.822), and total oxygen time (median: 24.00 h, IQR: 7.00-85.00 h and median: 21.00 h, IQR: 9.50-66.75 h, respectively; p = 0.779). Conclusion:In newborns with BW ≥ 1,500 g and moderate RD, the use of continuous flow NCPAP showed the same benefits as the use of variable flow NCPAP.J Pediatr (Rio J). 2011;87(6):499-504: Infant, newborn, ventilation, neonatal intensive care units. ResumoObjetivo: Avaliar a eficácia e segurança da pressão positiva contínua na via aérea (CPAP) utilizando aparelhos de fluxo variável e fluxo contínuo em selo d'água, quanto a falha do CPAP, ocorrência de escape de ar, tempo de uso de CPAP e de oxigênio e tempo de internação em unidade de terapia intensiva e hospitalar em neonatos com desconforto respiratório (DR) moderado e peso de nascimento (PN) ≥ 1.500 g. Métodos:Quarenta recém-nascidos que necessitavam de CPAP foram randomizados em dois grupos: um grupo tratado com fluxo variável (FV) e outro com fluxo contínuo (FC). O estudo foi realizado entre outubro de 2008 e abril de 2010. Foram registrados dados demográficos, falha do CPAP, ocorrência de escape de ar, tempo de uso de CPAP e de oxigênio, entre outros. Os desfechos categóricos foram analisados com o teste do qui-quadrado ou exato de Fisher e as variáveis contínuas com o teste de Mann-Whitney, com significância de p < 0,05. Resultados:Não houve diferença quanto aos dados demográficos, falha do CPAP (21,1 e 20,0% para o FV e o FC, respectivamente; p = 1,000), síndrome de escape de ar (10,5 e 5,0%, respectivamente; p = 0,605), tempo de CPAP [mediana: 22,0 h, intervalo interquartil (IIQ): 8,00-31,00 h e mediana: 22,0 h, IIQ: 6,00-32,00 h, respectivamente; p = 0,822), e tempo de uso de oxigênio (mediana: 24,00 h, IIQ:7,00-85,00 h e mediana: 21,00 h, IIQ:9,50-66,75 h, respectivamente; p = 0,779). Conclusão:Em r...

Volume Oscillations Delivered to a Lung Model Using 4 Different Bubble CPAP Systems

“…24 No differences were reported between the therapies for outcome measures of percentage CPAP failure, percentage barotrauma, duration of CPAP use, duration of oxygen use, ICU stay, and hospital stay. The findings suggest that the physiologic effect of the pressure oscillations from bubble CPAP is less prevalent as the lungs mature.…”

Nasal Jet-CPAP (variable flow) versus Bubble-CPAP in preterm infants with respiratory distress: an open label, randomized controlled trial

“…[8][9][10] Others have found no differences in clinical outcomes or physiological parameters. 11,19 Yagui et al 19 reported a similar CPAP failure rate by 72 h of life between variable flow Bober et al 13 reported a multicenter RCT from Poland comparing IFD with constant flow CPAP using ventilator in preterm infants ⩽ 32 weeks and birth weight of 750 to 1500 g in both primary treatment for RDS as well as post-extubation settings. Even though a combined analysis did not reveal any differences in the need for intubation, in the post-extubation setting, IFD had significantly lower failure rates but paradoxically higher rates of pneumothorax.…”

“…Small RCTs or crossover studies have compared Infant Flow Driver (IFD) to B-CPAP or ventilator (V-CPAP) for primary treatment of RDS. [8][9][10][11]19 Some authors have shown a 13 to 29% reduction in work of breathing, a better lung compliance at a pressure range of 4 to 7 cm H 2 0 and lesser oxygen requirements with IFD when compared with constant flow CPAP. [8][9][10] Others have found no differences in clinical outcomes or physiological parameters.…”

Nursing Care of the Newborn in Continuous Positive Airway Pressure: Review

“…17 Oksijen doygunluğu %88-94 arasında olacak şe-kilde (PEEP, FiO 2 ) ayarlamalarının yapılması gereklidir. 1 Bebekte burun yaralanması, nekrozu ve kanama gibi komplikasyonları önlemek için gerekli önlemler alınmalıdır. Her bebek için doğru boyutta kanül/maske seçilmeli, bebeğin burnuna kanül veya maske yerleştirmeden önce baş 30˚yükseltil-meli, omuzlar rulo ile desteklenerek başa koklama pozisyonu verilmelidir.…”