Departamento de Neonatología, Pontificia Universidad Católica de Chile, Santiago, Chile,
Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Neonatology. 2020;117(2):193-199. doi: 10.1159/000506164. Epub 2020 May 8.
Nasal continuous positive airway pressure (NCPAP) is a useful method of respiratory support after extubation. However, some infants fail despite CPAP use and require reintubation. Some evidence suggests that synchronized nasal intermittent positive pressure ventilation (NIPPV) may decrease extubation failure in preterm infants. Nonsynchronized NIPPV (NS-NIPPV) is being widely used in preterm infants without conclusive evidence of its benefits and side effects. Our aim was to evaluate whether NS-NIPPV decreases extubation failure compared with NCPAP in ventilated very low birth weight infants (VLBWI) with respiratory distress syndrome (RDS).
Randomized controlled trial of ventilated VLBWI being extubated for the first time. Before extubation, infants were randomized to receive NCPAP or NS-NIPPV. Primary outcome was the need for reintubation within 72 h.
220 infants were included. The mean ± SD birth weight was 1,027 ± 256 g and gestational age 27.8 ± 1.9 weeks. Demographic and clinical characteristics were similar in both groups. Extubation failure was 32.4% for NCPAP versus 32.1% for NS-NIPPV, p = 0.98. The frequency of deaths, bronchopulmonary dysplasia, intraventricular hemorrhage, air leaks, necrotizing enterocolitis and duration of respiratory support did not differ between groups.
In this population of VLBWI, NS-NIPPV did not decrease extubation failure after RDS compared with NCPAP.
经鼻持续气道正压通气（NCPAP）是拔管后呼吸支持的一种有效方法。然而，一些婴儿即使使用 CPAP 也会失败，需要重新插管。一些证据表明，同步鼻间歇正压通气（NIPPV）可能会降低早产儿的拔管失败率。非同步 NIPPV（NS-NIPPV）在早产儿中广泛应用，但没有明确的获益和副作用证据。我们的目的是评估在患有呼吸窘迫综合征（RDS）的通气极低出生体重儿（VLBWI）中，与 NCPAP 相比，NS-NIPPV 是否能降低拔管失败率。
对首次拔管的通气 VLBWI 进行随机对照试验。拔管前，婴儿被随机分为接受 NCPAP 或 NS-NIPPV。主要结局是 72 小时内需要再次插管。
共纳入 220 例婴儿。平均±SD 出生体重为 1027±256 g，胎龄为 27.8±1.9 周。两组的人口统计学和临床特征相似。NCPAP 组的拔管失败率为 32.4%，NS-NIPPV 组为 32.1%，p=0.98。两组的死亡率、支气管肺发育不良、颅内出血、气漏、坏死性小肠结肠炎和呼吸支持时间无差异。
在本研究的 VLBWI 人群中，与 NCPAP 相比，NS-NIPPV 并不能降低 RDS 后拔管失败率。
