A randomised controlled trial of two methods of delivering nasalcontinuous positive airway pressure after extubation to infantsweighing less than 1000 g: binasal (Hudson) versus single nasal prongs

摘要

OBJECTIVES—Primary: to determine whether nasal continuous positive airway pressure (CPAP) delivered through binasal prongs results in a greater proportion of extremely low birthweight infants being successfully extubated, after a period of intermittent positive pressure ventilation, than nasal CPAP delivered by a single nasal prong. Secondary: to evaluate the effect of mode of delivery of nasal CPAP after extubation on the need for endotracheal reintubation, weight gain, rates of feeding intolerance, sepsis, suspected sepsis, cranial ultrasound abnormalities, retinopathy of prematurity, chronic lung disease, and the duration of assisted ventilation and care in the tertiary neonatal unit.
DESIGN AND SETTING—Randomised, controlled, clinical trial conducted at the neonatal intensive care unit of the Royal Women's Hospital, Melbourne, Australia.
PATIENTS—Infants of birth weight less than 1000 g, ventilated, requiring < 50% oxygen and ventilator rate less than or equal to 20/minute, and considered by the clinical management team to be ready for extubation.
INTERVENTION—Infantswere randomly allocated to receive nasal CPAP delivered through binasal(Hudson) prongs or a single nasal prong.
PRIMARY OUTCOMEMEASURE—Failure of extubation as defined by thefollowing criteria: (a) apnoea (more thanone episode/hour over a six hour period or one episode requiring bagand mask ventilation); (b) absolute increasein oxygen requirement greater than 15% above that required beforeextubation; (c) respiratory acidosis(pH < 7.25 with PCO2 > 6.67 kPa).
RESULTS—Ten of the 41 (24%) infants randomised to binasal prongs reached predeterminedfailure criteria compared with 26 of the 46(57%) infants randomisedto a single nasal prong (p = 0.005). Four of 17 (24%) infants ofbirth weight less than 800 g extubated to binasal prongs reachedfailure criteria compared with 14 of 16 (88%) extubated to a singlenasal prong (p < 0.001). There were no significant differences inany of the secondary outcomes.
CONCLUSIONS—Forextremely low birthweight infants ventilated using an endotrachealtube, nasal CPAP delivered through binasal (Hudson) prongs is moreeffective in preventing failure of extubation than that deliveredthrough a single nasal prong.