2007 OPEN FORUM Abstracts
THE IMPACT AND DURATION OF EARLY NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE WHEN USED IN THE TREATMENT OF INFANTS WITH RESPIRATORY DISTRESS SYNDROME.
P. Cowan1, K. Shattuck2
Background: During 2003 nasal continuous positive airway pressure (NCPAP) was introduced as the initial management strategy for Respiratory Distress Syndrome (RDS) in the Infant Special Care Unit. The objective of this study was to determine if the use of early NCPAP reduced the need for mechanical ventilation and days on the ventilator and to characterize the NCPAP course in infants with RDS.
Methods: Infants with RDS were intubated, given surfactant then extubated to NCPAP (Infant Flow, Viasys Healthcare). They were re-intubated and ventilated for unacceptable hypoxemia, hypercarbia or profound apnea, but placed back on NCPAP when feasible. The NCPAP course for each patient was tracked until successful discontinuation from therapy. 2002 was defined as pre-NCPAP; January – December 2004 was defined as post-NCPAP. Data for mean ventilator days and percentage of infants requiring mechanical ventilation from January 2004 ± December 2006 was collected to determine if there was a sustained effect with the early NCPAP intervention. The number of days on NCPAP, postconceptual age (PCA), and weight at discontinuation was recorded for each patient from January 2004 – December 2006 to characterize the NCPAP course. Deaths were excluded from data analysis.
Results: Monthly ventilator days decreased from 236 ± 44 pre-NCPAP to 117 ± 7 post-NCPAP (means ± SD, p<0.0001). The number of babies intubated monthly decreased from 28 ± 3 pre-NCPAP to 15 ± 3 post-NCPAP (p<0.0001). The number of babies ventilated (n MV) and the mean time each baby required ventilator support (Days on Vent) decreased within each gestational age group (Table). There was a slight increase in the number of infants requiring mechanical ventilation and the mean number of ventilator days observed from January 2004 – December 2006 though these rates were still lower than those seen pre-NCPAP. Gestational age was inversely related to days on NCPAP and to postconceptual age (PCA) and weight at NCPAP discontinuation.
Conclusions: NCPAP reduces the need for mechanical ventilation in neonates at all gestational ages. Infants born between 30-32 weeks gestation typically require less than 7 days on NCPAP. Babies born at 26-29 weeks gestation are weaned from NCPAP at a mean of 30.5 weeks PCA and at a weight of approximately 1300 grams. Babies <or= 25 weeks gestation require longer courses of NCPAP, suggesting that factors other than RDS contribute substantially to their needs for respiratory support.
|GA (weeks)||n MV pre-CPAP||Mean Days on Vent||n MV post-CPAP||Mean Days on Vent||n MV Jan 2004 -Dec 2006||Mean Days on Vent|
|23-24||10/10||69 ± 20||7/7||42 ± 28||22/22||49 ± 26|
|25||7/7||54 ± 49||12/16||24 ± 25||30/36||30 ± 22|
|26||15/15||47 ± 41||11/20||21 ± 25||19/36||21 ± 22|
|27||12/12||20 ± 31||6/14||3 ± 2||13/32||18 ± 32|
|28||15/20||22 ± 59||1/12||12 ± 0||5/43||6 ± 5|
|29||17/22||5 ± 7||5/26||7 ± 9||12/51||7 ± 6|
|30-32||35/84||4 ± 5||11/100||3 ± 3||21/180||4 ± 4|