A prospective randomized controlled trial of nasal intermittent positive pressure ventilation for prevention of extubation failure in very low birth weight infants / 中国小儿急救医学

ABSTRACT

Objective To evaluate the efficacy of nasal intermittent positive pressure ventilation (nIPPV) in preventing extubation failure in very low birth weight infants (VLBWI) compared with nasal continuous positive airway pressure (nCPAP).Methods A single-center randomized controlled trial was conducted from Jun 2012 to Jun 2013 in the NICU of Children's Hospital of Hebei Province.Eighty-four cases of VLBWI (birth weight 700 ～ 1 500 g,gestational age 27 ～ 32 weeks) with respiratory failure and subjected to mechanical ventilation were eligible for the study if they needed non-invasive,assisted ventilation at the time of first extubation attempt.They were randomly assigned to receive nIPPV (40 cases) or nCPAP (44 cases) according to random number table method,using the rate of successful extubation as primary outcome.Blood gas data were obtained and PaO2,PaCO2,FiO2,PaO2/FiO2 were monitored at 0 h,24 h,48 h and 72 h after extubation as enrollment for oxygenation and duration,the rate of successful extubation and the incidence of adverse events including frequent apnea,bronchopulmonary dysplasia,intraventricular hemorrhage,periventricular leukomalacia and retinopathy of prematurity and mortality as secondary outcomes.Results There were no significant differences in the baseline characteristics including the proportion of primary disease,sex,weight,gestational age,score for neonatal acute physiology and application of pulmonary surfactant between nIPPV group and nCPAP group (P ＞ 0.05).There were no significant differences in PaO2,PaCO2 and PaO2/FiO2 ratio between the two groups at 0 h of enrollment (P ＞ 0.05).The values of PaO2 and PaO2/FiO2 ratio in nIPPV group were significantly higher[48 hPaO2(63.2 ± 3.6) mmHg vs (52.3 ±6.7) mmHg,PaO2/FiO2(243.2 ±32.8) mmHg vs (187.6 ±34.0) mmHg;72 hPaO2(66.4 ±5.8) mmHg vs (51.8±5.9) mmHg,PaO2/EO2(280.6 ± 16.8) mmHg vs (245.2 ±40.5) mrnHg;1 rnmHg =0.133 kPa],whereas PaCO2 lower[48 h(40.3 ±4.8) mmHg vs (49.2 ±6.6) mmHg,72 h(42.2 ±5.6) mmHg vs (57.3 ± 6.9) mmHg],than nCPAP group at 48 h and 72 h after extubation (P ＜ 0.05).The oxygenation status in nIPPV group were significantly improved at 48 h and 72 h after extubation compared with the intra-group data at 0 h (P ＜ 0.05).The total ventilation time was shorter in nIPPV group than nCPAP group[(130.9 ±46.7) h vs (180.5 ±50.1) h,P ＜0.05],but the oxygen exposure time had no significant difference[(190.6 ± 45.2) h vs (216.8 ± 54.4) h,P ＞ 0.05].The rate of successful extubation in nIPPV group was significantly higher as compared with nCPAP group[92.5％ (37/40) vs 75.0％ (33/44),P ＜ 0.05].The incidence of frequent apnea and bronchopulmonary dysplasia in nIPPV was lower than nCPAP group[15.0％ (6/40) vs 34.1％ (15/44) ;2.5％ (1/40) vs 15.9％ (7/44),P ＜ 0.05].There were no significant differences in the incidence of severe intraventricular hemorrhage,perivenwicular leukomalacia,retinopathy of prematurity,late of infections,necrotizing enterocolitis,patent ductus arteriosus,patent ductus arteriosus operation and mortality before discharge between the two groups (P ＞ 0.05).Conclusion nIPPV after extubation in VLBWI has beneficial effects as compared with nCPAP in improving oxygenation,shortening noninvasive ventilation time,improving the rate of successful extubation,and can reduce the incidence of frequent apnea and bronchial pulmonary dysplasia in VLBWI.