Randomized Controlled Trial of Nonsynchronized Nasal Intermittent Positive Pressure Ventilation versus Nasal CPAP after Extubation of VLBW Infants

Abstract

Background and Objectives: Nasal continuous positive airway pressure (NCPAP) is a useful method of respiratory support after extubation. However, some infants fail despite CPAP use and require reintubation. Some evidence suggests that synchronized nasal intermittent positive pressure ventilation (NIPPV) may decrease extubation failure in preterm infants. Nonsynchronized NIPPV (NS-NIPPV) is being widely used in preterm infants without conclusive evidence of its benefits and side effects. Our aim was to evaluate whether NS-NIPPV decreases extubation failure compared with NCPAP in ventilated very low birth weight infants (VLBWI) with respiratory distress syndrome (RDS). Methods: Randomized controlled trial of ventilated VLBWI being extubated for the first time. Before extubation, infants were randomized to receive NCPAP or NS-NIPPV. Primary outcome was the need for reintubation within 72 h. Results: 220 infants were included. The mean ± SD birth weight was 1,027 ± 256 g and gestational age 27.8 ± 1.9 weeks. Demographic and clinical characteristics were similar in both groups. Extubation failure was 32.4% for NCPAP versus 32.1% for NS-NIPPV, p = 0.98. The frequency of deaths, bronchopulmonary dys-Clinical Trial Registration: study registered at ClinicalTrials.gov NCT01778829.

Efficacy and safety of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure ventilation in neonatal respiratory distress syndrome: a systematic review and meta-analysis

“…NIPPV also has advantages in reducing the oxygen inhalation time and the incidence of BPD. Another recent RCT ( 17 ) showed that NIPPV and NCPAP had similar effects on neonatal RDS; there was no reported difference in the incidence of intubation, BPD, and mortality between the NIPPV and NCPAP groups. Moreover, there was also no difference in the incidence of intraventricular hemorrhage, pneumothorax, and invasive ventilation time between the two groups.…”

“…We retrieved 1,867 literatures from the database, and finally selected 10 literatures for study (15)(16)(17)(20)(21)(22)(23)(24)(25)(26). The 10 literatures included 1,104 patients, 557 in the NIPPV group and 547 in the NCPAP group.…”

“…No adverse events were observed in NIPPV and NCPAP. However, a recent randomized controlled trial (RCT) ( 17 ) reported no difference in the incidence of endotracheal intubation between NIPPV and NCPAP in the treatment of neonatal RDS. NIPPV does not provide benefits to RDS newborns in terms of mortality, BPD, sepsis, and atelectasis.…”