Post extubation nasal intermittent positive pressure ventilation vs nasal continuous positive air way pressure in respiratory distress syndrome

Abstract

RDS occurs primarily in premature infants; its incidence is inversely related to gestational age and birth weight. In previous decades, it was common to initiate endotracheal intubation and mechanical ventilation in neonates with moderate or severe respiratory distress. However, it is now known that such actions may have adverse effects on the respiratory system. Improvements in the measurement of volume and flow in modern neonatal ventilators have led to a variety of alternative NIV procedures. The pulmonary management of preterm infants is directed at minimizing the need for prolonged mechanical ventilatory support to reduce associated complications such as barotrauma, volutrauma, oxygen toxicity, subglottic stenosis, and nosocomial infections. Nevertheless, early discontinuation of mechanical ventilation often presents difficulties due to residual lung damage, apnea, and atelectasis (Bhat et al., 1986). Various techniques have been proposed to insure successful removal of the endotracheal tube. These include use of NCPAP, NIPPV and use of respiratory center stimulants (Durand et al., 1987). Our objective in this study was to compare the effects of NIPPV and NCPAP in the duration of ventilation and extubation failure used in a population of preterm infants with RDS, enrolled after weaning from mechanical ventilation and needed noninvasive respiratory support, as a primary outcomes, and incidence of apnea, pneumothorax, PCo2, GIT complications, BPD, duration of hospitalization and mortality as a secondary outcomes. Thirty preterm neonates enrolled to the study, after taking consent from the parents and randomization, fifteen of them were allocated to NIPPV group and the other fifteen allocated to NCPAP group after they were extubated from MV. As for the primary outcomes we found that the median duration of non-invasive ventilation required in both groups was not significantly significant (IQR: 4 vs 3 respectively) (p = .148). Two out of 15 neonates in the NIPPV group versus five out of 15 in the NCPAP group, needed secondary invasive mechanical ventilation i.e. respiratory failure after extubation in the NIPPV group was lower than in NCPAP group but this difference was not low enough to reach statistically significant level (13.3% vs 33.3% respectively) (