Nasal CPAP vs Bi-level Nasal CPAP in preterms with RDS: a randomized control study

Abstract

Background: Ventilator induced lung injury prevention may begin from birth, and respiratory support without endotracheal intubation is an attractive option in preterm baby with Respiratory distress syndrome (RDS). The objective of the study was to evaluate the clinical course and respiratory outcomes in preterm infants with moderate RDS assigned from birth to Nasal Continuous Positive Airway Pressure (NCPAP) or Bi-level Nasal Continuous Positive Airway Pressure (Bi-level NCPAP).Methods: 60 infants of 28-34 weeks GA (<35 wks GA), affected by moderate RDS, were considered eligible and were randomized to NCPAP (CPAP level=6cm H2O, Group A n=30) or to Bi-level NCPAP (lower CPAP level=4.5 cmH2O; higher CPAP level=8 cmH2O, Group B n=30), provided with the variable flow devices (Infant Flow CPAP vs Infant Flow SiPAP™, Viasys Healthcare, Yorba Linda, CA).Results: Length of ventilation, oxygen dependency, need for intubation and occurrence of air leaks were considered as outcomes. Infants showed similar characteristics at birth (Group A versus Group B: GA 30.4±2 wks versus 30.3±2wks, BW 1433±545g versus 1415±560g. Group A underwent longer respiratory support (6,2±2 days versus 3,8±1 days, p=0.025), longer O2 dependency (13,8±8 days versus 6,5±4 days, p=0.027) and was discharged later (GA at discharge 36,7±2,5 weeks versus 35,6±1,2 weeks, p=0.02). All infants survived. No BPD or neurological disorders occurred.Conclusions: Bi-level NCPAP was associated with better respiratory outcomes versus NCPAP, and allowed earlier discharge, inducing the same changes in the cytokine levels. In our population, it was well tolerated and safe

Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: A randomized controlled trial

“…This is also justi ed by improved alveolar deployment, improvement respiratory function and early respiratory system stability in patients treated under NDUOPAP treatment. These ndings are consistent with those of Arora et al [31] and Lista et al [19].…”

“…There was a statistically signi cant difference between the two groups (P = 0.002). The results were consistent with those of Lista et al [19] and Arora et al [31]. This may be due to lower duration of non-invasive ventilation and oxygen therapy and earlier stabilization of the patient's respiratory status.…”

“…In this study mortality was the same in both groups, probably because the number of treatment failure and prematurity complications were similar in both groups, which is similar to the studies of Arora et al [31], Salvo et al [35], and Gao et al [29]. There was no signi cant difference between the two groups in terms of presence pneumothorax (p = 0.497), which is consistent with the results of Zhou et al [11] and Lista et al [19].…”

“…In the present study, arterial blood PaO 2 levels were also compared one hour after treatment in the NDUOPAP and NCPAP neonates, which were 72.21 ± 5.37 mmHg and 67.01 ± 6.57 mmHg, respectively, showing a signi cant difference between the two groups. This nding is also justi ed by the use of alveolar volume, ow and increased mean airway pressure [MAP]) in patients treated with NDUOPAP [11,31]. The ndings of our study were similar to those of Zhuo et al [11] and Kong et al [18].…”

“…Many studies have investigated the incidence of PBD between different modes. Zhou et al [11], Arora et al [31] Rong et al [36], and Lista et al [19] obtained similar results.…”