Does continuous positive airway pressure (CPAP) during weaning from intermittent mandatory ventilation in very low birth weight infants have risks or benefits? A controlled trial

Abstract

We were unable to demonstrate a clear difference in extubation outcome by use of CPAP administered via an endotracheal or nasopharyngeal tube when compared to direct extubation from low-rate IMV in VLBW infants.

Changes in respiratory pattern during continuous positive airway pressure in infants after cardiac surgery

“…Using 2-h T-piece trials, Esteban et al [3] initially reported earlier and successful extubation in adult medical or surgical patients, compared with synchronized intermittent mandatory ventilation and pressure support ventilation; more recently, half-hour T-piece trials were shown to be as effective as 2-h trials [4]. For infants, however, there have been few reports of spontaneous breathing trials [5,6,11]. In the present study of infants, we found that tolerance of 30-min CPAP trials was 92% predictive of successful extubation.…”

“…On the other hand, extended CPAP may cause respiratory distress. Tapia et al [5] reported that the extubation failure rates for very-low-birthweight infants were similar with the strategy of direct extubation from intermittent mandatory ventilation (2/30, 7%) and the use of CPAP trials lasting 12-24 h (4/28, 14%). They speculated that the use of a narrow endotracheal tube for small infants may increase the work of breathing and cause respiratory fatigue.…”

“…In a follow-up study, 30-min T-piece trials were as effective as 2-h trials [4]. For infants, however, few investigations have examined whether a spontaneous breathing test, in the current study a continuous positive airway pressure (CPAP) trial, provides smooth weaning [5,6].…”

A review on noninvasive ventilation: The Cochrane Systematic Reviews 2006

“…There are eight trials that address the use of CDP as a method to stabilize infants after extubation. [21][22][23][24][25][26][27][28] Most of these trials occurred in the 1990s. Infants extubated to nasal CPAP experienced a reduction in respiratory failure, leading to the need for additional ventilator support [typical RR 0.62 (95% CI 0.49, 0.77), typical RD À0.17 (95% CI À0.24, À0.10)].…”

Elective use of nasal continuous positive airways pressure following extubation of preterm infants

“…Randomized trials assessing the elective use of nasal continuous positive airways presure (nCPAP) post-extubation in preterm infants have yielded con¯icting results regarding its in¯uence on extubation success and have been of insucient sample size to give meaningful data on long-term outcome [2,3,6,7,11,12]. A further factor which may have in¯uenced its application is that sustained use of nCPAP may not be practical in all infants because they became extremely agitated [3] or hyperoxic.…”