Capasso Letizia, Borrelli Angela Carla, Cerullo Julia, Caiazzo Maria Angela, Coppola Clara, Palma Marta, Raimondi Francesco
Department of Translational Medical Sciences, Division of Neonatology, University "Federico II", Naples, Italy.
J Matern Fetal Neonatal Med. 2022 Apr;35(7):1272-1277. doi: 10.1080/14767058.2020.1749256. Epub 2020 Apr 7.
Continuous positive airway pressure (CPAP) is currently used in neonates after mechanical ventilation though it may occasionally be associated with air leaks syndromes or it may fail to support the baby. The pressure difference offered by bilevel continuous positive distending pressure (BiPAP) respect to CPAP may be an advantage to the spontaneously breathing patient. In this study, we compared the efficacy of CPAP and BiPAP in the firstweek post-extubation in a series of very preterm infants.
Inborn neonates less than 30 weeks of gestational age who were intubated shortly after birth from January 2011 to December 2017 were enrolled in a retrospective study. The attending clinician assessed the patients for non-invasive respiratory support readiness and allocated them to CPAP (PEEP 4-6 cmHO) or BiPAP (PEEP 4-5 cmHO, rate 10-40; Thigh 0.7-1.2; upper-pressure level 8-10 cmHO). Both techniques were compared for preventing extubation failure within 7 days from extubation as defined per local protocol (primary outcome). Secondary outcomes were: definitive failure of extubation, pneumothorax during non-invasive respiratory support, periventricular leukomalacia, bronchopulmonary dysplasia, sepsis, patent ductus arteriosus and retinopathy of prematurity at discharge.
We enrolled 134 neonates; the CPAP group included 89 babies while 45 received BiPAP. Patients did not differ for their general characteristics (EG, antenatal steroids, incidence of SGA, maternal hypertension, surfactant replacement therapy). Short term extubation failure was significantly higher in the former group (23/89 in CPAP vs 5/45 in BiPAP; = .005). No infant developed air leak syndrome. Secondary outcomes were comparable between groups. Multivariate analysis showed that on the whole population the extubation failure was correlated to the insurgence of late-onset sepsis.
BiPAP safely reduced early extubation failure compared to CPAP in our cohort of very preterm neonates within 7 days from extubation.
持续气道正压通气（CPAP）目前用于机械通气后的新生儿，尽管它偶尔可能与空气泄漏综合征相关，或者可能无法支持婴儿。双水平持续气道正压通气（BiPAP）相对于CPAP提供的压力差可能对自主呼吸的患者有利。在本研究中，我们比较了一系列极早产儿拔管后第一周内CPAP和BiPAP的疗效。
纳入2011年1月至2017年12月出生后不久即插管的孕周小于30周的足月儿进行回顾性研究。主治医生评估患者是否准备好接受无创呼吸支持，并将他们分配到CPAP组（呼气末正压4 - 6cmH₂O）或BiPAP组（呼气末正压4 - 5cmH₂O，频率10 - 40；吸气时间0.7 - 1.2；高压水平8 - 10cmH₂O）。比较两种技术在拔管后7天内预防拔管失败的情况（根据当地方案定义为主要结局）。次要结局包括：拔管最终失败、无创呼吸支持期间气胸、脑室周围白质软化、支气管肺发育不良、败血症、动脉导管未闭和出院时早产儿视网膜病变。
我们纳入了134例新生儿；CPAP组包括89例婴儿，45例接受BiPAP。两组患者的一般特征（孕周、产前使用类固醇、小于胎龄儿发生率、母亲高血压、表面活性剂替代治疗）无差异。前一组的短期拔管失败率显著更高（CPAP组89例中有23例，BiPAP组45例中有5例；P = 0.005）。没有婴儿发生空气泄漏综合征。两组的次要结局具有可比性。多因素分析表明，在总体人群中，拔管失败与迟发性败血症的发生相关。
在我们的极早产儿队列中，与CPAP相比，BiPAP在拔管后7天内安全地降低了早期拔管失败率。
