Comparison of Nasal Continuous Positive Airway Pressure and Nasal Intermittent Mandatory Ventilation in Early Respiratory Support of Very Low Birth Weight Infants with Respiratory Distress Syndrome

It is common practice to use endotracheal continuous positive airway pressure for various time periods up to 24 hours before attempting extubation in infants who are mechanically ventilated. A few studies in newborns have indicated that airway resistance is increased through small endotracheal tubes. This increases the work of breathing and the likelihood of subsequent ventilatory failure. In this study, 27 very low birth weight infants who were ½ to 28 days old at the time of extubation were randomly divided into two groups. One group of 13 study infants were extubated directly from intermittent mandatory ventilation rates of six to ten per minute, and the other 14 control infants were placed on continuous positive airway pressure through endotracheal tubes for six hours prior to an attempt to extubate. There was no difference between the two groups in gestational age, postnatal age, weight, or severity of lung disease at the time of extubation. All 13 study infants were successfully extubated without significant apnea or respiratory acidosis. Of the 14 control infants, only seven were successfully extubated; six infants had significant apnea and in one infant respiratory acidosis with pH 7.13 and Pco2 65 developed while receiving continuous positive airway pressure (13/13 v 7/14, P < .005). The seven infants who failed the preextubation trial of continuous positive airway pressure were later extubated from low intermittent mandatory ventilation rates without significant pnea or respiratory acidosis. Furthermore, slight CO2 retention developed in the very low birth weight infants after six hours of continuous positive airway pressure but not after direct extubation (mean change Pco2 ± SD: 4.43 ± 3.87 v -0.23 ± 3.79 mm Hg, P < .01). This study demonstrates that the recommended preextubation trial of continuous positive airway pressure through an endotracheal tube is not only unnecessary but detrimental to very low birth weight infants, in whom more apnea and slight CO2 retention develop probably because of increased airway resistance through small endotracheal tubes.

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Heated Humidified High Flow Nasal Cannula (HHHFNC) is not an effective method for initial treatment of Respiratory Distress Syndrome (RDS) versus nasal intermittent mandatory ventilation (NIMV) and nasal continuous positive airway pressure (NCPAP)

Journal of Research in Medical Sciences ◽

10.4103/jrms.jrms_2_19 ◽

2019 ◽

Vol 24 (1) ◽

pp. 73

Author(s):

Ramin Iranpour ◽

Amir-Mohammad Armanian ◽

Mehdi Parvaneh ◽

Nima Salehimehr ◽

Awat Feizi ◽

...

Keyword(s):

Continuous Positive Airway Pressure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Initial Treatment ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

High Flow ◽

High Flow Nasal Cannula ◽

Intermittent Mandatory Ventilation

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Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial

BMC Pediatrics ◽

10.1186/s12887-021-02741-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Arash Malakian ◽

Mohammad Reza Aramesh ◽

Mina Agahin ◽

Masoud Dehdashtian

Keyword(s):

Mechanical Ventilation ◽

Continuous Positive Airway Pressure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Abstract Background The most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications. Methods 148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to duo positive airway pressure (NDUOPAP) group and 74 neonates to nasal continuous positive airway pressure (NCPAP) group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 h after birth and secondary outcomes included treatment complications. Results there was not significant difference between DUOPAP (4.1 %) and NCPAP (8.1 %) in treatment failure at the first 72 h of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Need for repeated doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. The duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also, the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002). Conclusions In the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 h of birth, but the duration of non-invasive ventilation and oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group. Trial registration IRCT20180821040847N1, Approved on 2018-09-10.

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