Ventilator modes in neonatal intensive care unit: introduction of bubble continuous positive airway pressure

ABSTRACT

The association of conventional mechanical ventilation [CMV] with the later development of bronchopulmonary dysplasia [BPD] called for trials of noninvasive modalities. The first introduction of Continuous Positive Airway Pressure [CPAP] in 1971 by Gregory et al., was followed by many other studies and different techniques. We included 81 neonates with respiratory distress syndrome [RDS] of all weights and all gestational ages. They were divided into two period groups according to the time of introduction of bubble CPAP to the Neonatal Intensive Care Unit [NICU] as 1st period [before introduction of CPAP] and 2[nd] period [after introduction of CPAP], also divided to further groups according to their birth weights. Comparing respiratory outcomes as duration of ventilation, failed extubation, duration of CPAP, duration of apnea, duration of oxygen therapy and postmenstrual age [PMA] off oxygen. The non-respiratory outcomes were also reviewed as duration of total parenteral nutrition [TPN], incidence of necrotizing enterocolitis [NEC] or intraventricular hemorrhage [IVH]. Thirty nine percent of infants in the 2[nd] period were assisted by BCPAP, whether as the only ventilatory support, after weaning from CMV or before the need for CMV or ventilator derived CPAP. Less intubations were reported in low birth weight infants [P=0.037], less surfactant was used in normal birth weights [P=0.01]. However, the duration of CPAP was longer in LBW and VLBW in 2nd period [P = 0.000 and 0.002 respectively]. Also, longer duration of O2 therapy in LBW and ELBW in the 2[nd] period [P = 0.015 and 0.032 respectively]. No significantly associated apneas, ICH or NEC. The non-respiratory outcome of both study periods in all weight groups, were similar. There was no significant difference in the incidence of respiratory complications among the different ventilation modes, and between different weight groups in both periods. No associated air leak among those assisted by BCPAP. No difference in the incidence of non respiratory complications in different ventilation modes. It was concluded that Hudson prong bubble continuous positive airway pressure therapy is a non invasive respiratory support that is promising to reduce the need for invasive mechanical ventilation of infants with respiratory distress. Institution of Early Nasal Continuous Airway Pressure [ENCPAP] as a preferred method for initial airway management seems to require time to demonstrate its optimum feasibility and efficacy