Postextubation Noninvasive Ventilation in Respiratory Distress Syndrome: A Randomized Controlled Trial

Rania A. El-Farrash; Robert M. DiBlasi; Eman A. AbdEL-Aziz; Adham M. El-Tahry; Mohammed S. Eladawy; Mourad A. Tadros; Mohamed A. Koriesh; John V. Farid; Riham S. AbdElwahab; Medhat A. Elsayed; Noha M. Barakat

doi:10.1055/s-0041-1723999

American Journal of Perinatology, Table of Contents

Am J Perinatol 2022; 29(14): 1577-1585
DOI: 10.1055/s-0041-1723999

Original Article

Postextubation Noninvasive Ventilation in Respiratory Distress Syndrome: A Randomized Controlled Trial

Rania A. El-Farrash

¹Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Robert M. DiBlasi

²Department of Respiratory Care, Seattle Children's Hospital and Research Institute, Seattle, Washington

,

Eman A. AbdEL-Aziz

¹Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Adham M. El-Tahry

¹Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Mohammed S. Eladawy

¹Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Mourad A. Tadros

³Department of Pediatrics and Neonatology, Algalaa Gynecology and Children's Military Hospital, Cairo, Egypt

,

Mohamed A. Koriesh

⁴Getinge Group, Middle East, Dubai

,

John V. Farid

⁵Ministry of Health, Cairo, Egypt

,

Riham S. AbdElwahab

⁵Ministry of Health, Cairo, Egypt

,

Medhat A. Elsayed

⁶Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Noha M. Barakat

¹Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt

› Author Affiliations

Abstract

Objective Successful extubation and prevention of reintubation remain primary goals in neonatal ventilation. Our aim was to compare three modalities of postextubation respiratory support—noninvasive positive pressure ventilation (NIPPV), nasal bilevel positive airway pressure (N-BiPAP), and nasal continuous positive airway pressure (NCPAP)—using the RAM cannula in preterm neonates with respiratory distress syndrome (RDS). Our secondary aim was to define the predictors of successful extubation.

Study Design A total of 120 preterm neonates (gestational age ≤35 weeks) with RDS who had undergone primary invasive ventilation were randomized to receive either NIPPV, N-BiPAP, or NCPAP. The incidence of respiratory failure in the first 48 hours postextubation, total days of invasive and noninvasive ventilation, duration of hospitalization, and mortality were measured and compared among the three different noninvasive support modalities.

Results There were no significant differences in the postextubation respiratory failure rates and the number of days of invasive as well as noninvasive ventilation among the three different support modalities (p > 0.05). The total number of days of mechanical ventilation and the duration of hospitalization were significantly higher in the N-BiPAP group than those in the NCPAP or NIPPV groups (p < 0.05). A gestational age of at least 29 weeks and a birth weight of at least 1.4 kg were predictive of successful extubation with a sensitivity of 98.2 and 85.3% and a specificity of 63.6 and 90.9%, respectively.

Conclusion Longer durations of mechanical ventilation and hospitalization were observed with N-BiPAP as a noninvasive mode of ventilation, but there was no significant difference in the extubation failure rates among the three modalities. Gestational age and birth weight were shown to be independent predictors of successful extubation of preterm neonates with RDS.

Key Points

Successful extubation and reintubation prevention of preterms are primary goals in neonatal ventilation.
NIPPV, N-BiPAP, and NCPAP could be used as postextubation noninvasive modes in preterm neonates.
Gestational age and birth weight are independent predictors of successful extubation of preterms.

Keywords

noninvasive positive pressure ventilation - nasal bilevel positive airway pressure - nasal continuous positive airway pressure - RAM cannula

Full Text

References

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