USC Division of Neonatal Medicine, LAC+USC Medical Center, Good Samaritan Hospital and Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA.
J Perinatol. 2012 May;32(5):336-43. doi: 10.1038/jp.2012.1. Epub 2012 Feb 2.
To compare the effect of early extubation to nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) on the need for mechanical ventilation via endotracheal tube (MVET) at 7 days of age in preterm infants <30 weeks' gestation requiring intubation and surfactant for respiratory distress syndrome (RDS) within 60 min of delivery.
Multicenter, randomized, controlled trial. A total of 57 infants were randomized within 120 min of birth to NCPAP (BW 1099 g and GA 27.8 weeks) and 53 infants to NIPPV (BW 1052 g, and GA 27.8 weeks). Infants were stabilized on NCPAP at birth and were given poractant alfa combined with MVET within 60 min of age. When stabilized on MVET, they were extubated within the next hours or days to NCPAP or NIPPV.
A total of 42% [corrected] of infants needed MVET at 7 days of age in the NCPAP group compared with 17% in the NIPPV group (OR: 3.6; 95% CI: 1.5, 8.7). Days on MVET were 12 ± 11 days in NCPAP group compared with 7.5 ± 12 days in the NIPPV group (median 1 vs 7 days; P=0.006). Clinical bronchopulmonary dysplasia (BPD) was 39% in the NCPAP group compared to 21% in the NIPPV group (OR: 2.4; 95% CI: 1.02, 5.6). Physiological BPD was 46% in the NCPAP group compared with 11% in the NIPPV group (OR: 6.6, 95% CI: 2.4, 17.8; P=0.001). There were no differences in any other outcomes between the two groups.
NIPPV compared with NCPAP reduced the need for MVET in the first week, duration of MVET, and clinical as well as physiological BPD in preterm infants receiving early surfactant for RDS.
比较经鼻间歇正压通气（NIPPV）与经鼻持续气道正压通气（NCPAP）对胎龄<30 周、需要气管内插管和表面活性物质治疗呼吸窘迫综合征（RDS）的早产儿在出生后 60 分钟内接受治疗，并在 7 天时通过气管内插管（MVET）需要机械通气的影响。
多中心、随机、对照试验。共有 57 名婴儿在出生后 120 分钟内随机分为 NCPAP 组（BW 1099 g，GA 27.8 周）和 53 名婴儿分为 NIPPV 组（BW 1052 g，GA 27.8 周）。NCPAP 组在出生时稳定，并在出生后 60 分钟内给予猪肺表面活性剂联合 MVET。当在 MVET 上稳定时，在接下来的几个小时或几天内将其气管内拔管至 NCPAP 或 NIPPV。
NCPAP 组有 42%[校正]的婴儿在 7 天时需要 MVET，而 NIPPV 组为 17%（OR：3.6；95%CI：1.5，8.7）。NCPAP 组的 MVET 天数为 12±11 天，NIPPV 组为 7.5±12 天（中位数 1 与 7 天；P=0.006）。NCPAP 组临床支气管肺发育不良（BPD）为 39%，NIPPV 组为 21%（OR：2.4；95%CI：1.02，5.6）。NCPAP 组生理 BPD 为 46%，NIPPV 组为 11%（OR：6.6，95%CI：2.4，17.8；P=0.001）。两组在其他任何结局上均无差异。
与 NCPAP 相比，NIPPV 可减少接受早期表面活性物质治疗 RDS 的早产儿在第一周内对 MVET 的需求、MVET 的持续时间以及临床和生理 BPD。
