Department of Pediatrics WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India.
Indian J Pediatr. 2012 Sep;79(9):1163-8. doi: 10.1007/s12098-011-0651-2. Epub 2011 Dec 23.
To compare the efficacy of bubble and conventional nasal continuous positive airway pressure (CPAP) in preventing extubation failure (EF) in preterm infants.
Infants of gestation ≤32 wk and birth weight <1500 g, ready for initial extubation within first wk of life were randomly allocated to either bubble (n = 16) or conventional (n = 16) CPAP. A standardized protocol was used for extubation. Bubble CPAP was delivered by Fischer and Paykel equipment using short binasal prongs and conventional CPAP was delivered by a ventilator using Argyle short binasal prongs. CPAP was initiated at a pressure of 4-6 cm of H(2)O and FiO(2) of 0.4-0.5 and adjusted to maintain normal saturation (90-93%) and comfortable breathing. Primary outcome was EF, defined as need for mechanical ventilation within 72 h of extubation.
Baseline characteristics including birth weight (g; 1027 ± 243 vs. 1018 ± 227; p = 0.83), gestation (wk; 28.7 ± 1.8 vs. 28.4 ± 1.6; p = 0.30), infants <28 wk gestation (6 vs. 7, p = 0.72) were comparable between the two groups. Respiratory distress syndrome was the indication for ventilation in 13 (81%) and 14 (87%) infants on bubble CPAP and conventional CPAP groups respectively. (p = 0.99). There was no difference in the EF rates between the bubble (n = 4) and conventional CPAP (n = 9) groups. (RR 0.49; 95% CI 0.20-1.2; p = 0.14). Median time to extubation failure was also comparable between the two groups (h; median [range]: 29 [14-49] vs. 17 [7-28]; p = 0.35).
The possibility that bubble CPAP may be associated with reduced EF as suggested in this pilot study requires further investigation in an adequately powered multicentric study.
比较气泡和常规鼻塞持续气道正压通气（CPAP）在预防早产儿拔管失败（EF）中的疗效。
将胎龄≤32 周且出生体重<1500g、出生后第一周内准备首次拔管的婴儿随机分配至气泡（n=16）或常规（n=16）CPAP 组。采用标准化方案进行拔管。气泡 CPAP 由菲舍尔和佩克尔设备通过短双鼻插管输送，常规 CPAP 由 Argyle 短双鼻插管输送。CPAP 在 4-6cm H2O 的压力和 0.4-0.5 的 FiO2 下开始，并根据需要调整以维持正常饱和度（90-93%）和舒适呼吸。主要结局为 EF，定义为拔管后 72 小时内需要机械通气。
两组的基线特征包括出生体重（g；1027±243 与 1018±227；p=0.83）、胎龄（wk；28.7±1.8 与 28.4±1.6；p=0.30）、胎龄<28 周的婴儿（6 与 7，p=0.72）在两组之间无差异。呼吸窘迫综合征是 13 例（81%）和 14 例（87%）接受气泡 CPAP 和常规 CPAP 治疗的婴儿进行通气的指征。（p=0.99）。在气泡 CPAP 组（n=4）和常规 CPAP 组（n=9）中，EF 发生率无差异。（RR 0.49；95%CI 0.20-1.2；p=0.14）。两组的拔管失败中位时间也无差异（h；中位数[范围]：29[14-49]与 17[7-28]；p=0.35）。
这项初步研究表明，气泡 CPAP 可能与降低 EF 有关，但这一可能性需要在一项充分有力的多中心研究中进一步调查。
