Weaning Premature Infants from Nasal Continuous Positive Airway Pressure – Current Practice and Scientific Evidence

Abstract

Objective In the past decade, a number of trials have been conducted to determine the optimal strategy of weaning premature infants from nasal continuous airway pressure (nCPAP). However, a paucity of information exists on how weaning is actually performed in clinical routine. Aim of this study was to investigate the current practice of weaning premature infants from nCPAP in Germany.

Methods An online survey was performed in German tertiary care neonatal units.

Results All 160 German tertiary care units were contacted. Replies were retrieved from 85/160 (53%) units, of which 83/160 (52%) completed the questionnaire. 66/83 (80%) respondents indicated to wean without the use of formal written policies. In 44/83 (53%) units weaning decisions are made jointly between physicians and nurses, whereas physicians are the sole decision makers in 33/83 (40%) as are nurses in 6/83 (7%) units. Many units use more than one weaning strategy. 81/83 units (98%) gradually reduce nCPAP pressure as the initial step in the weaning process. 9/83 (11%) units stop nCPAP at standard criteria [CICADA (CeasIng nCpap At standarD criteriA) method] and 58/83 (70%) units use a cycling nCPAP on/off strategy. 52/83 (63%) of the responding units use nasal high flow at least at some point during the weaning process, either as a gradual weaning method or during nCPAP breaks.

Conclusion Weaning strategies from nCPAP vary widely in German tertiary care neonatal units. It appears that evidence is still insufficient to promote a distinct weaning strategy which in turn highlights the urgent need for further adequately powered clinical trials.

Zusammenfassung

Ziel Um die optimale Entwöhnungsmethode Frühgeborener von nasaler CPAP-Beatmung zu bestimmen, wurden in den letzten 10 Jahren eine Reihe von klinischen Studien durchgeführt. Es fehlen jedoch Informationen darüber, wie derzeit in der klinischen Routine entwöhnt wird. Ziel dieser Untersuchung war es, die aktuelle Entwöhnungspraxis in Deutschland zu untersuchen.

Methodik Es wurde eine Online-Umfrage unter allen Level-1 Perinatalzentren in Deutschland durchgeführt.

Ergebnisse Alle 160 deutschen Level-1 Perinatalzentren wurden kontaktiert. Antworten wurden von 85/160 (53%) Zentren erhalten. 83/160 (52%) Antworten waren vollständig. 66/83 (80%) Befragte gaben an, ohne schriftlich festgelegte Richtlinien zu entwöhnen. In 44/83 (53%) Zentren trifft ärztliches und pflegerisches Personal die Entwöhnungsentscheidung gemeinsam. Die alleinige Entscheidung treffen Ärztinnen und Ärzte in 33/83 (40%) sowie Pflegende in 6/83 (7%) Zentren. Viele Zentren verwenden mehr als eine Entwöhnungsmethode. 81/83 (98%) Zentren reduzieren als ersten Entwöhnungsschritt graduell den nCPAP Druck. 9/83 (11%) Zentren beenden nCPAP anhand prädefinierter Kriterien [sog. CICADA (CeasIng nCpap At standarD criteriA) Methode]. 58/83 (70%) Zentren verwenden eine Strategie mit sich verlängernden nCPAP Pausen. 52/83 (63%) Zentren nutzen nasale High Flow Therapie im Laufe des Entwöhnungsprozesses, entweder als eine Form der graduellen Entwöhnung oder in nCPAP Pausen.

Schlussfolgerung Die Strategien zur Entwöhnung von nCPAP variieren in deutschen Level-1 Perinatalzentren beträchtlich. Die wissenschaftliche Evidenz scheint noch zu gering, als dass eine bestimmte Entwöhnungsstrategie empfohlen werden könnte. Das wiederum unterstreicht die Notwendigkeit weitere aussagekräftige klinische Studien durchzuführen.

Key words

NCPAP - weaning - survey - prematurity - Germany

Schlüsselwörter

Nasaler CPAP - Entwöhnung - Umfrage - Frühgeburtlichkeit - Deutschland

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