Protocol for a randomised controlled trial comparing two CPAP levels to prevent extubation failure in extremely preterm infants

Kidman, Anna Madeline; Manley, Brett J.; Boland, Rosemarie A; Malhotra, Atul; Donath, Susan; Davis, Peter G; Bhatia, Risha

doi:10.1136/bmjopen-2020-045897

Cited by 7 publications

(2 citation statements)

References 17 publications

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“…CPAP and early initiation of noninvasive ventilation should be explored in well-designed clinical trials given their promising results in preventing extubation failure. (38)(39)(40) This study provides important data on the use of RSS and OSI for early identification of moderate preterm infants at risk of NRS failure. However, there are several notable limitations.…”

Section: Manuscriptmentioning

confidence: 98%

Respiratory Severity Score and Oxygen Saturation Index during the First 2 Hours of Life as Predictors for Noninvasive Respiratory Support Failure in Respiratory Distress Syndrome

Zapata,

Koueik,

Becker

et al. 2024

Am J Perinatol

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Background: Noninvasive respiratory support (NRS) failure is common in preterm infants with respiratory distress syndrome (RDS). We evaluated the utility of Respiratory Severity Score (RSS) and Oxygen Saturation Index (OSI) during the first two hours of life (HOL) as a predictor for NRS failure in moderate preterm infants. Methods: We conducted a retrospective cohort study of infants born between 28 0/7 to 33 6/7 weeks with RDS. Univariate and multivariable logistic regression analysis were used to assess whether the RSS and OSI summary measures were associated with NRS failure. Results: A total of 282 infants were included in the study. Median GA and birthweights were 32 weeks and 1.7 Kg respectively. Fifty eight infants (21%) developed NRS failure at median age of 10.5 hours. RSS and OSI summary measures in the first 2 HOL were associated with NRS failure within 72 HOL. Conclusion: RSS and OSI during the first two HOL can predict NRS failure. Optimal RSS and OSI cutoffs for prediction of NRS failure need to be determined in large cohort studies.

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Section: Manuscriptmentioning

confidence: 98%

Respiratory Severity Score and Oxygen Saturation Index during the First 2 Hours of Life as Predictors for Noninvasive Respiratory Support Failure in Respiratory Distress Syndrome

Zapata,

Koueik,

Becker

et al. 2024

Am J Perinatol

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“…14 Further studies on the choice of initial postextubation pressures and settings on noninvasive modes, especially in relation to preextubation settings, are warranted such as the ongoing trial comparing postextubation CPAP levels of 10 vs. 7 cm H 2 O. 15…”

Section: Comparison To Previous Literaturementioning

confidence: 99%

Toward Optimal High Continuous Positive Airway Pressure as Postextubation Support in Preterm Neonates: A Retrospective Cohort Study

Khalid¹,

Albalushi²,

Manoj³

et al. 2022

Am J Perinatol

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Objective: To evaluate whether the initial pressure level on High CPAP (≥9 cmH2O), in relation to pre-extubation mean airway pressure (Paw), influences short-term clinical outcomes in preterm neonates. Design/Methods: In this retrospective-cohort study, preterm neonates <29 weeks’ gestational age (GA) extubated from mean Paw ≥9 cmH2O and to High CPAP (≥9 cmH2O) were classified into “Higher-level CPAP” (2-3 cmH2O higher than pre-extubation Paw) and “Equivalent CPAP” (-1 to +1 cmH2O in relation to pre-extubation Paw). Only the first eligible extubation per infant was analyzed. The primary outcome was failure within ≤7 days of extubation, defined as any one or more of: (a) need for re-intubation, (b) escalation to an alternate non-invasive respiratory support mode, or (c) use of CPAP >pre-extubation Paw +3 cmH2O. Secondary outcomes included individual components of the primary outcome, along with other clinical and safety outcomes. Results: Over a 10 year period (Jan 2011 to Dec 2020), 175 infants were extubated from mean Paw >9 cmH2O to High CPAP pressures. Twenty-seven subjects [median (IQR) GA 24.7 (24.0-26.4) weeks and chronological age 31 (21-40) days] were classified into the “Higher-level CPAP” group while 148 infants [median (IQR) GA 25.4 (24.6-26.6) weeks and chronological age 26 (10-39) days] comprised the “Equivalent CPAP” group. There was no difference in the primary outcome (44% vs. 51%; P=0.51), including post-adjustment for confounders (adjusted OR 0.47 [95% CI 0.17-1.29; P=0.14]). However, re-intubation risk within 7 days was lower with Higher-level CPAP (7% vs. 37%; P<0.01), including post-adjustment (aOR 0.07; 95% CI 0.02-0.35; P<0.01). Conclusions: In this cohort, use of initial distending CPAP pressures 2-3 cmH2O higher than pre-extubation Paw did not alter the primary outcome of failure, but did lower the risk of re-intubation. The latter is an interesting hypothesis-generating finding that requires further confirmation.

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Postoperative Respiratory Management in Pediatric Cardiac Surgical Patients

Dabbagh

2023

Congenital Heart Disease in Pediatric and Adult Patients

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Protocol for a randomised controlled trial comparing two CPAP levels to prevent extubation failure in extremely preterm infants

Cited by 7 publications

References 17 publications

Respiratory Severity Score and Oxygen Saturation Index during the First 2 Hours of Life as Predictors for Noninvasive Respiratory Support Failure in Respiratory Distress Syndrome

Respiratory Severity Score and Oxygen Saturation Index during the First 2 Hours of Life as Predictors for Noninvasive Respiratory Support Failure in Respiratory Distress Syndrome

Toward Optimal High Continuous Positive Airway Pressure as Postextubation Support in Preterm Neonates: A Retrospective Cohort Study

Postoperative Respiratory Management in Pediatric Cardiac Surgical Patients

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