OBJECTIVE: To compare the efficacy of nasal synchronized intermittent mandatory ventilation (nSIMV) and nasal continuous positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS).
METHODS: Fifty preterm infants with RDS who received pulmonary surfactant were randomized to nSIMV and nCPAP groups after extubation. Clinical signs, symptoms and blood gas results following nSIMV or nCPAP were compared in the two groups.
RESULTS: Compared with the nCPAP group, the nSIMV group had a lower incidence of failure respiratory support (24% vs 60%; P<0.05), a lower incidence of hypercarbonia (12% vs 40%; P<0.05) and a lower incidence of hypoxia (24% vs 36%; P<0.05).
CONCLUSIONS: nSIMV is more effective in respiratory support in preterm infants with RDS.
BACKGROUND: Nasal flow-synchronized intermittent positive pressure ventilation (NFSIPPV) is a new non-invasive ventilatory mode that delivers synchronized mechanical breaths through the nasal prongs. An unmasked, prospective randomized controlled trial was conducted to compare the efficacy of NFSIPPV and conventional nasal continuous positive airway pressure (NCPAP) in increasing the likelihood for successful extubation in very low-birthweight infants.
METHODS: Consecutive infants who weighed <1251 g at birth, required endotracheal intubation within 48 h of birth and met specific predetermined criteria for extubation by day 14 of life were recruited. Each infant was randomized to receive either NFSIPPV or NCPAP soon after extubation. Extubation was deemed successful if re-intubation was not needed for at least 72 h. Criteria for re-intubation were persistent severe respiratory acidosis (arterial pH <7.20 with pCO2 >70 mmHg), severe recurrent apneic episodes not responding to increased ventilatory settings and then requiring bag ventilation, and hypoxemia (SaO2 <90% or pO2 <60 mmHg with FiO2 > or =0.70).
RESULTS: There were no significant differences in clinical characteristics between the two groups at randomization. Ninety-four percent (30/32) infants were successfully extubated to NFSIPPV but only 61% (19/31) to conventional NCPAP (P > 0.005). Infants assigned to NCPAP failed extubation mainly because of apnea and hypercapnia, and those assigned to NFSIPPV because of hypoxia. Neither procedure induced major adverse effects.
CONCLUSIONS: NFSIPPV in the post-extubation period is safe and more effective than NCPAP in preventing re-ventilation.
OBJECTIVE: To compare the rate of reintubation within 7 days after extubation and study the complications in premature infants who were randomized in the immediate postextubation period to either nsNIMV or NCPAP. MATERIAL AND METHOD: This study was conducted in the neonatal unit of Queen Sirikit National Institute of Child Health between June 1 and November 30, 2006. Intubated premature infants born at GA < or = 34 weeks or with birth weight < or = 1500 gm, ready to be extubated before 4 weeks of age were recruited. Infants were randomized to either nsNIMV or NCPAP after extubation. Non-synchronized NIMV setting was the same as ventilator setting before extubation and NCPAP pressure was set at the same mean airway pressure of pre extubation ventilator value. Extubation was performed after intravenous loading dose of aminophylline. Primary outcome measurement was reintubation within 7 days of initial extubation and the secondary outcome was possible complications such as apnea, abdominal distension, gastrointestinal (GI) perforation, necrotizing enterocolitis (NEC), sepsis and death. RESULTS: A total of 70 VLBW infants were admitted to the neonatal unit during the study period. A total of 57 infants were intubated of which 48 infants were recruited for the study; 24 were in the nsNIMV group and 24 were in the NCPAP group. Infants in the nsNIMV group had mean birth weight and body weight at the start of study less than that in the NCPAP group (984.8 +/- 218 vs. 1067 +/- 214 and 1185 +/- 219 vs. 1205 +/-191, p = 0.003, 0.02). The nsNIMV group also had a higher rate of RDS and antenatal steroid used when compared to the NCPAP group (19/24 vs. 12/24 and 17/24 vs. 8/24, p = 0.03, 0.01). The nsNIMV group had fewer males than in the NCPAP group (8/24 vs. 17/24, p = 0.01). Reintubation was similar in both groups but atelectasis and sepsis were statistically significant risk factor for reintubation in NCPAP group. There were no significant differences in treatment related complications between the two groups, with respect to incidence of apnea (41.7% in nsNIMV vs. 62.5% in NCPAP), abdominal distensions (8.3% in nsNIMVvs. 16.7% in NCPAP), NEC (4.2% in nsNIMVvs. 12.5 in NCPAP), sepsis (4.2% in nsNIMVvs. 8.3% NCPAP). No GI perforation was observed in both groups. CONCLUSION: Non-invasive mode of ventilation, both NIMV and NCPAP, for weaning ofpre-term infants from ventilator may reduce the rate of reintubation in this group. Both modes seem to be equally safe. We believe that the use of non-invasive ventilator techniques will significantly reduce neonatal morbidity in the future. Additional prospective evaluation of these approaches should be conducted in the future.
To compare the efficacy of nasal synchronized intermittent mandatory ventilation (nSIMV) and nasal continuous positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS).
METHODS:
Fifty preterm infants with RDS who received pulmonary surfactant were randomized to nSIMV and nCPAP groups after extubation. Clinical signs, symptoms and blood gas results following nSIMV or nCPAP were compared in the two groups.
RESULTS:
Compared with the nCPAP group, the nSIMV group had a lower incidence of failure respiratory support (24% vs 60%; P<0.05), a lower incidence of hypercarbonia (12% vs 40%; P<0.05) and a lower incidence of hypoxia (24% vs 36%; P<0.05).
CONCLUSIONS:
nSIMV is more effective in respiratory support in preterm infants with RDS.
