Randomized study of nasal continuous positive airway pressure in the preterm infant with respiratory distress syndrome

Tooley, James; Dyke, M

doi:10.1111/j.1651-2227.2003.tb02479.x

Cited by 53 publications

(23 citation statements)

References 22 publications

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“…The use of surfactant and NCPAP decreased the need for mechanical ventilation from 100% in the control group to 62% in the NCPAP group. 28 Similar results were published by Dani et al 29 showing a lesser need for mechanical ventilation in patients who after administration of surfactant were randomized to NCPAP vs mechanical ventilation.…”

Section: Cpap Prophylaxis Vs Treatmentsupporting

confidence: 79%

Continuous positive airway pressure: early, late, or stay with synchronized intermittent mandatory ventilation?

Bancalari

Moral

2006

J Perinatol

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Mechanical ventilation is associated with significant short-and long-term morbidity in small preterm infants. Continuous positive airway pressure applied through nasal prongs is an effective, less-invasive method to improve gas exchange and reduce apnea in these infants. A large number of studies have evaluated the possibility of reducing the need or duration of mechanical ventilation by early use of nasal continuous positive airway pressure shortly after birth and by applying it after extubation. Although results of these trials have not been consistent, most of the evidence suggests that nasal continuous positive airway pressure is a viable alternative to mechanical ventilation in many preterm infants and that its use after extubation contributes to maintain better lung function and reduces apnea. Despite this, there is no evidence that these beneficial short-term effects translate into lower rates of long-term morbidity such as bronchopulmonary dysplasia and neurologic sequelae or mortality rates.

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Section: Cpap Prophylaxis Vs Treatmentsupporting

confidence: 79%

Continuous positive airway pressure: early, late, or stay with synchronized intermittent mandatory ventilation?

Bancalari

Moral

2006

J Perinatol

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“…The failure to make an impact on the incidence of BPD despite decreasing the amount of time spent on the ventilator has been shown in previous studies evaluating NCPAP. 13,19 Unexpectedly, we found improved growth of our infants in the HFNC group. Although we have maintained the same nutritionist, enteral feeding practices, and aggressive parenteral nutrition support in our unit over the entire period of the study, it is difficult to attribute this improvement solely to the HFNC without a prospective randomized study.…”

mentioning

confidence: 58%

Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol

2007

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Objective: Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) are frequent complications of prematurity. To decrease ventilator-induced lung injury, we evaluated the safety, efficacy and neonatal outcomes of a heated humidified high-flow nasal cannula (HFNC) system and an early extubation protocol (EEP) designed for preterm infants 25 to 29 weeks' gestational age (GA). Result: Inclusion criteria were met by 49/57 infants in the control group and 65/75 infants in the HFNC group. The groups had similar demographics, perinatal conditions, birthweight, GA, timing and total doses of surfactant. There were no differences in rates of extubation failure, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, laser eye surgery, sepsis, BPD at 28 days and 36 weeks and death. The groups did not differ in oxygen use, i.v. steroid days, or parenteral nutrition days. Days to reach full feeds were similar. Infants in the HFNC group were extubated from a higher ventilator rate (32.6±8.5 vs 28±7.5, P ¼ 0.003) and spent fewer days on the ventilator (11.4±12.8 vs 18.5±21, P ¼ 0.028). Rates of ventilatorassociated pneumonia were higher in the control group (P ¼ 0.018). Discharge weights were greater in the HFNC group (P ¼ 0.016) despite similar length of stay and GA at discharge. Conclusion:High-flow nasal cannula use appears safe and well-tolerated. Infants extubated to HFNC spent fewer days on the ventilator. Additional benefits may include a decreased rate of ventilator associated with pneumonia and improved growth.

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“…In this small-scale study, surfactant treatment significantly reduced the need for subsequent mechanical ventilation (43% in surfactant-treated infants, as compared with 85% in controls, p = 0.003). Several additional trials using INSURE followed [31,36,37,38,39]. While some of these studies demonstrated a significantly decreased need for mechanical ventilation after INSURE [37,38], this apparent benefit did not translate into decreased rates of mortality or BPD [40].…”

Section: The 2000s: Old Roads Revisitedmentioning

confidence: 99%

“…Although experience with early CPAP to stabilize preterm infants and avoid invasive mechanical ventilation has greatly increased, success with this approach is limited [39,40]. Nasal intermittent positive pressure ventilation could potentially improve noninvasive respiratory support [68,69].…”

Section: The Future: Any Leaps In Sight?mentioning

confidence: 99%

The Journey Towards Lung Protective Respiratory Support in Preterm Neonates

Berger

Fontana

Stocker³

2013

Neonatology

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The aim of this conceptual review is to provide the reader with a broad perspective on progress made in respiratory support of preterm infants over the past five decades. Landmark discoveries are described in their historical context and underlying theories of lung protection are discussed. The review finishes by integrating different approaches and perspectives into a state-of-the-art concept for lung-protective ventilation in this fragile patient population. Improvements in neonatal respiratory support in the 1970s and 1980s have contributed to dramatic improvements of mortality and morbidity rates among neonates with respiratory failure. Continuous positive airway pressure, antenatal corticosteroids and surfactant replacement therapy revolutionized the care of preterm infants. With the recognition that atelectrauma, volutrauma and oxygen toxicity are the main factors contributing to ventilator-induced lung injury, lung-protective strategies, including noninvasive respiratory support, tidal volume targeting during conventional mechanical ventilation and high frequency ventilation were developed in the 1990s. Given the fact that progress made in the last decade has only resulted in minor improvements in mortality and morbidity rates of neonates with respiratory failure, it seems unlikely that further refinements of current technologies will produce giant leaps forward in high-resource countries. It appears that entirely new approaches would be required. In contrast, knowledge and technology transfer of basic respiratory support strategies (e.g. use of oxygen, simple systems to provide continuous positive airway pressure), could have an enormous impact on the prognosis of neonates with respiratory failure in low-resource countries.

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Randomized study of nasal continuous positive airway pressure in the preterm infant with respiratory distress syndrome

Cited by 53 publications

References 22 publications

Continuous positive airway pressure: early, late, or stay with synchronized intermittent mandatory ventilation?

Continuous positive airway pressure: early, late, or stay with synchronized intermittent mandatory ventilation?

Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol

The Journey Towards Lung Protective Respiratory Support in Preterm Neonates

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