Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation

Abstract

Objective:To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV) after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (nCPAP). Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA) ≤ 36 weeks and birth weight (BW) > 750 g, who required tracheal intubation and mechanical ventilation. The study was controlled and randomized in order to ensure that the members of the groups used in the research were chosen at random. Randomization was performed at the time of extubation using sealed envelopes. Extubation failure was defined as the need for re-intubation and mechanical ventilation during the first 72 hours after extubation. Results: Among the 36 premature infants randomized to nIPPV, six (16.6%) presented extubation failure in comparison to 11 (30.5%) of the 36 premature infants randomized to nCPAP. There was no statistical difference between the two study groups regarding BW, GA, classification of the premature infant, and MV time. The main cause of extubation failure was the occurrence of apnea. Gastrointestinal and neurological complications did not occur in the premature infants participating in the study. Conclusion: We found that, despite the extubation failure of the group of premature infants submitted to nIPPV being numerically smaller than in premature infants submitted to nCPAP, there was no statistically significant difference between the two modes of ventilatory support after extubation.

Non-synchronized nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) after extubation in preterm infants with respiratory distress syndrome

“…Furthermore, we did not detect significant differences in the rates of neonatal morbidities including sepsis, pneumothorax, IVH, ROP, BPD, BPD/death rates or mortality between the groups. Nonetheless, consistent with the study of Komatsu et al (6) , the incidence of hsPDA was higher in the NIPPV group, compared to the NCPAP group in our study. hsPDA was defined as the ductus arteriosus having a diameter of ≥1.5 mm and a ratio of ≥1.5 between the size of the left atrium and the diameter of the aortic root and diastolic reversal of blood flow in the aorta on portable echocardiography (30) .…”

“…In the literature, gastrointestinal complications such as abdominal distension, feeding intolerance, NEC, and intestinal perforation did not differ between the neonates assigned to NIPPV or NCPAP following extubation (6,11,(21)(22)(23) . Although there is a limited number of data on abdominal distension and feeding intolerance in our study, intestinal perforation was not observed in any of the infants.…”

“…Consistent with our results, Jasani et al (23) showed that, compared to NCPAP, the use of NIPPV did not reduce the need for reintubation and mechanical ventilation during the first 72 hrs of extubation. In addition, Komatsu et al (6) reported that there was no statistically significant difference between the two methods of noninvasive ventilation performed after extubation.…”

“…Nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) have been widely used in preterm infants as a mode of noninvasive ventilation after extubation (4)(5)(6) . CPAP improves PaO 2 , decreases airway resistance, improves obstructive apnea, and stabilizes the chest wall and reduces its distortion by increasing the functional residual capacity (7) .…”

Efficacy of noninvasive respiratory support modes as postextubation respiratory support in preterm neonates: A systematic review and network meta‐analysis

“…Ten studies were adjudged as having a high risk of bias due to issues in random sequence generation and allocation concealment. 30,32,33,39,40,[43][44][45]47,53 Eight studies had a low risk of bias 21,23,25,26,42,48,50,52 and fifteen studies had variable risk of bias. 22,24,[27][28][29]31,[34][35][36][37][38]41,46,49,51 Due to the nature of the intervention, blinding of the personnel and outcome assessor was not possible and hence all the trials scored a high risk of bias for the same.…”