ABSTRACT
BACKGROUND: Prolonged use of mechanical ventilation is associated with some complications as high mortality and high morbidities as bronchopulmonary dysplasia, ventilator-associated pneumonia, and pneumothorax. However, extubation failure in preterm infants is still high (40-60%) in very low birth weight infants (VLBW). Noninvasive neurally adjusted ventilatory assistance (NIV-NAVA) is triggered by the diaphragmatic electrical activity through a nasogastric tube that synchronizes patient/ventilator respiration, cycle by cycle effectively shortening the assisted cycle trigger and the degree of ventilatory assistance, optimizing the effects of intermittent inspiratory pressure on nasal continuous positive airway pressure (NCPAP). This study aims to compare reintubation rates until 72 h after extubation in preterm infants of high risk for reintubation using NIV-NAVA or NCPAP. METHODS: A retrospective study of chart review data collection was performed in a private tertiary hospital. The study was approved by the local institutional Ethics Committee. We included infants considered at high risk of reintubation (BW < 1000 grams; use of invasive mechanical ventilation (IMV) for at least 7 days; or previous extubation failure episode) and compared the two groups according to the type of respiratory support after extubation: (1) NCPAP (n = 32); or (2) NIV-NAVA (n = 17). Demographics data were collected, the primary outcome was reintubation rate until 72 h after extubation. Secondary outcome was time to reintubation, BPD rate, IVH grade ≥ III, pneumothorax and death. RESULTS: There was no difference between both groups in demographic data. The reintubation rate decreased significantly in the NIV-NAVA group compared to NCPAP (50.0-11.7, p < .02) despite the significantly higher length of invasive mechanical ventilation (IMV) before extubation attempt in NIV-NAVA group (12.4 versus 5.5 days, p < .04). There was no difference between both groups in secondary outcomes. CONCLUSIONS: In this small retrospective cohort study, the use of NIV-NAVA as postextubation strategy was effective in reducing extubation failure within 72 h in preterm infants when compared to traditional NCPAP.
Subject(s)
Interactive Ventilatory Support , Noninvasive Ventilation , Airway Extubation , Continuous Positive Airway Pressure , Humans , Infant , Infant, Newborn , Infant, Premature , Retrospective StudiesABSTRACT
OBJECTIVES: To compare rates of treatment failure between the use of nasal continuous positive airway pressure (NCPAP) and noninvasive neurally adjusted ventilatory assist (NIV-NAVA) in infants with respiratory distress after birth. METHODS: A randomized, unblinded, double-center trial was conducted in infants with birth weights (BWs) less than or equal to 1500 g and respiratory distress receiving noninvasive respiratory support for less than or equal to 48 hours of life; some infants were initially treated with minimally invasive surfactant therapy as the standard of care. PRIMARY OUTCOME: need for endotracheal intubation with use of mechanical ventilation (MV) at less than or equal to 72 hours of life using prespecified failure criteria. SECONDARY OUTCOMES: use of surfactant, duration of noninvasive support, duration of MV, bronchopulmonary dysplasia (BPD) and death. RESULTS: A total of 123 infants were included (NCPAP group = 64 and NIV-NAVA group = 59). Population characteristics were similar between groups. No difference in the primary outcome was observed: NCPAP = 10 (15.6%) and NIV-NAVA = 12 (20.3%), P = .65. Groups were also similar in the use of surfactant (19 vs 17), duration of noninvasive support (147 ± 181 hours vs 127 ± 137 hours), BPD incidence and death. However, duration of MV was significantly longer in NCPAP group (95.6 ± 45.8 hours vs 28.25 ± 34.1 hour), P = .01. CONCLUSION: In infants with respiratory distress after birth, no differences in treatment failures were observed between NIV-NAVA and NCPAP. These results require further evaluation in a larger study.
