Heath Jeffery Rachael C, Broom Margaret, Shadbolt Bruce, Todd David A
Australian National University Medical School, Canberra.
Department of Neonatology, Centenary Hospital, Canberra.
J Paediatr Child Health. 2016 Mar;52(3):321-6. doi: 10.1111/jpc.13087.
A previous randomised controlled trial (RCT) in babies born < 30 weeks gestation found the so-called CICADA method (ceasing continuous positive airways pressure (CPAP) with a view to remain off rather than slow weaning) significantly reduced CPAP time. Post-RCT we introduced the CICADA method and evaluated whether the improved outcomes of the CICADA method during the RCT were replicated in clinical practice.
The aim of the study is to compare cardio-respiratory outcomes in PBs < 30 weeks GA over three epochs: (i) pre RCT, (ii) during RCT and (iii) post RCT implementation.
The study used prospective data to compare baseline characteristics and cardio-respiratory outcomes over the three epochs.
There were 270/393(69%) PBs < 30 weeks GA who fulfilled the inclusion criteria over the three epochs. No significant differences were found in GA or birthweight between the three epochs (27.9 ± 1.3, 27.7 ± 1.4, 28.0 ± 1.3 (weeks ± 1 standard deviation); and 1100 ± 252, 1086 ± 251, 1094 ± 320 (grams ± 1 standard deviation)). There were significant decreases in CPAP days and corrected GA to cease CPAP post implementation (20.5 ± 2.1, 21.1 ± 2.1, 16.5 ± 1.8 (days ± SE); P = 0.006 and 33.3 ± 0.4, 33.5 ± 0.4, 32.6 ± 0.4 (weeks ± SE); P = 0.01). Compared with the pre RCT epoch, there were significant reductions in patent ductus arteriosus (36/78 (46%), 33/87 (37%), 18/103 (17%); P < 0.001) and chronic lung disease (40/78 (51%), 19/87 (21%), 30/103 (29%); P < 0.001).
CPAP time, corrected GA to cease CPAP, patent ductus arteriosus and chronic lung disease significantly reduced following the introduction of the CICADA method. Early cessation of CPAP expedites the transition from neonatal intensive care to special care.
先前一项针对孕周小于30周的婴儿的随机对照试验（RCT）发现，所谓的CICADA方法（停止持续气道正压通气（CPAP）以期维持无CPAP状态而非缓慢撤机）显著缩短了CPAP使用时间。RCT结束后，我们引入了CICADA方法，并评估该方法在RCT期间改善的结局在临床实践中是否得以重现。
本研究的目的是比较孕周小于30周的早产婴儿在三个阶段的心肺结局：（i）RCT前，（ii）RCT期间，以及（iii）RCT实施后。
本研究使用前瞻性数据比较三个阶段的基线特征和心肺结局。
在三个阶段中，共有270/393（69%）名孕周小于30周的早产婴儿符合纳入标准。三个阶段之间的孕周或出生体重无显著差异（27.9±1.3、27.7±1.4、28.0±1.3（周±1标准差）；以及1100±252、1086±251、1094±320（克±1标准差））。实施CICADA方法后CPAP使用天数及停止CPAP时的矫正孕周显著减少（20.5±2.1、21.1±2.1、16.5±1.8（天±标准误）；P = 0.006以及33.3±0.4、33.5±0.4、32.6±0.4（周±标准误）；P = 0.01）。与RCT前阶段相比，动脉导管未闭（36/78（46%）、33/87（37%）、18/103（17%）；P < 0.001）和慢性肺病（40/78（51%）、19/87（21%）、30/103（29%）；P < 0.001）显著减少。
引入CICADA方法后，CPAP使用时间、停止CPAP时的矫正孕周、动脉导管未闭和慢性肺病均显著减少。早期停止CPAP可加速从新生儿重症监护向特殊护理的过渡。
