2006 OPEN FORUM Abstracts
The Effects of Noninvasive Positive Pressure Ventilation versus Nasal CPAP on Extubation Success in Neonates with Respiratory Distress Syndrome
Deakins RRT NPS, Mary Nock MD Rainbow
Babies &Children's Hospital Cleveland, OH
Introduction: The administration of nasal continuous positive airway pressure (NCPAP) following the extubation of premature infants with Respiratory Distress Syndrome (RDS) has been shown to reduce the length of time spent on mechanical ventilation and decrease the incidence of re-intubation. In our institution, VLBW infants (birth weight <1500g) are routinely placed on variable flow (VF) nasal CPAP following extubation. In 2005, a non invasive positive pressure ventilation (NPPV) mode, (Biphasic), was introduced for infants using the Infant Flow SiPAP Plus (Viasys Health Care.) This device delivers non-synchronized intermittent positive pressure breaths through nasal prongs or mask. To date, the efficacy of delivering NPPV to premature infants has not been well described. The purpose of this evaluation was to compare extubation success using NPPV Biphasic mode and NCPAP on infants with RDS. Methods From April 2005 to April 2006, in a nonrandomized retrospective evaluation, virtually all 121 VLBW infants in our tertiary level NICU were extubated to either NCPAP or Biphasic mode following mechanical ventilation per RDS carepath protocol. 51% of ventilated infants (63) were extubated to VF CPAP, the standard of care in our NICU, at +5 cm H20 (using the Infant flow device), with a measured mean airway pressure at 5 cm H20, while (48%)or 58 were extubated to Bi-Phasic mode with mask or nasal prongs at the following settings: frequency 10- 20/min, inspiratory time 1.0 seconds, Phi 8 cm H20 and Plo 5 cm H20 per suggested recommendations, with a measured mean airway pressure of 6 cm H20. Infants remained on the NCPAP or Biphasic for a duration dictated by their clinical condition and at the physician's discretion. Outcomes of success of extubation on VF CPAP for 7 days were compared to the outcomes of infants receiving Biphasic NPPV using the Binomial Test with a p value set at ≤ 0.05 to indicate statistical significance.
Results: The mean gestational age of VLBW infants in the NCPAP group was 27 weeks with an average birth weight of 905g. In the Biphasic group (n = 58), the mean gestation was 26 weeks with an average weight of 832g. The overall success of extubation for 7 days on VF NCPAP was 65% and 70 % on Biphasic NPPV mode. There was no statistically significant difference in extubation success between Biphasic NPPV and the standard of care, NCPAP.
Conclusion: Early clinical experience and observations of patients placed on the Biphasic mode of NPPV, although used at a slightly higher mean airway pressure than NCPAP, suggests that Biphasic NPPV is comparable to CPAP for providing noninvasive support following extubation in the VLBW population.