Does Continuous Positive Airway Pressure (CPAP) During Weaning From Intermittent Mandatory Ventilation in Very Low Birth Weight Infants Have Risks or Benefits? A Controlled Trial

Pediatr Pulmonol. 1995 May;19(5):269-74. doi: 10.1002/ppul.1950190505.

Abstract

Objective: The purpose of this study was to evaluate three ventilator weaning strategies and to evaluate whether the use of continuous positive airway pressure (CPAP) via a nasopharyngeal or endotracheal tube would increase the likelihood of extubation failure in very low birth weight (VLBW) infants.

Study design: We studied prospectively 87 preterm infants (mean +/- SD; birth weight: 1078 +/- 188 g; gestational age: 28.8 +/- 2.2 weeks) who were in the process of being weaned from intermittent mandatory ventilation (IMV). Infants were assigned by systematic sampling to one of the following three treatment groups: (1) direct extubation from IMV (D.EXT) (n = 30); (2) preextubation endotracheal CPAP (ET-CPAP) for 12-24 hr (n = 28); or (3) postextubation nasopharyngeal CPAP (NP-CPAP) for 12-24 hr (n = 29). Failure was defined as the need for resumption of mechanical ventilation within 72 hr of extubation due to frequent or severe apnea and/or respiratory failure (pH < 7.25, PaCO2 > 60 mm Hg, and/or requirement for oxygen FiO2 > 60%).

Results: There were no significant differences in failure rates among the three procedures. Failures were 2/30 (7%) in D.EXT; 4/28 (14%) in ET-CPAP; and 7/29 (24%) in the NP-CPAP. There were also no differences in FiO2, PaO2, and respiratory rates before and after discontinuation of IMV among the three groups. PaCO2 values were slightly higher in the NP-CPAP group 12-24 hr after weaning from IMV.

Conclusion: We were unable to demonstrate a clear difference in extubation outcome by use of CPAP administered via an endotracheal or nasopharyngeal tube when compared to direct extubation from low-rate IMV in VLBW infants.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Airway Resistance
  • Analysis of Variance
  • Apnea / epidemiology
  • Apnea / etiology
  • Female
  • Humans
  • Incidence
  • Infant, Low Birth Weight*
  • Infant, Newborn
  • Intermittent Positive-Pressure Ventilation / instrumentation*
  • Intermittent Positive-Pressure Ventilation / methods
  • Intubation, Intratracheal / methods
  • Male
  • Positive-Pressure Respiration / instrumentation*
  • Positive-Pressure Respiration / methods
  • Prospective Studies
  • Respiration, Artificial
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*
  • Risk Factors
  • Ventilator Weaning*