Randomised controlled trial of weaning strategies for preterm infants on nasal continuous positive airway pressure
نویسندگان
چکیده
BACKGROUND The optimal strategy for weaning very preterm infants from nasal continuous positive airway pressure (NCPAP) is unclear. Reported strategies include weaning NCPAP to a predefined pressure then trialling stopping completely (abrupt wean); alternate periods of increased time off NCPAP whilst reducing time on until the infant is completely weaned (gradual wean); and using high flow nasal cannula (HFNC) to assist the weaning process. The aim of this study was to determine the optimal weaning from NCPAP strategy for very preterm infants. METHODS A pilot single centre, factorial design, 4-arm randomised controlled trial. Sixty infants born <30 weeks gestation meeting stability criteria on NCPAP were randomly allocated to one of four groups. Group 1: abrupt wean with HFNC; Group 2: abrupt wean without HFNC; Group 3: gradual wean with HFNC; Group 4: gradual wean without HFNC. The primary outcomes were duration of respiratory support, chronic lung disease, length of hospital stay and time to full suck feeds. RESULTS The primary outcome measures were not significantly different between groups. Group 1 had a significant reduction in duration of NCPAP (group 1: median 1 day; group 2: 24 days; group 3: 15 days; group 4: 24 days; p = 0.002) and earlier corrected gestational age off NCPAP. There was a significant difference in rate of parental withdrawal from the study, with group 2 having the highest rate. Group 3 had a significantly increased duration on HFNC compared to group 1. CONCLUSIONS Use of high flow nasal cannula may be effective at weaning infants from NCPAP but did not reduce duration of respiratory support or time to full suck feeds. Abrupt wean without the use of HFNC was associated with an increased rate of withdrawal by parent request. TRIAL REGISTRATION This study is registered at the Australian New Zealand Clinical Trials Registry ( www.anzctr.org.au/). (Registration Number = ACTRN12610001003066).
منابع مشابه
Sudden Complete Versus Gradual Weaning from Nasal Continuous Positive Airway Pressure in Preterm Neonates: A Randomized Controlled Trial
Background: Continuous positive airway pressure (CPAP) is used as respiratory support in preterm neonates; however, the best weaning method has not yet been determined. In this study, we compared sudden complete and gradual weaning from nasal CPAP (NCPAP) in preterm newborns. Methods: This randomized controlled trial was conducted on 62 prete...
متن کاملA Comparative Study of Treatment Response of Respiratory Distress Syndrome in Preterm Infants: Early Nasal Intermittent Positive Pressure Ventilation versus Early Nasal Continuous Positive Airway Pressure
Background Infant respiratory distress syndrome (IRDS) is one of the main causes of serious complications and death in preterm infants. Both Nasal Continuous Positive Airway Pressure (NCPAP) and Nasal Intermittent Positive Pressure Ventilation (NIPPV) are known as the most common treatment strategies for IRDS. The present study intended to compare NCPAP and NIPPV in the treatment of preterm inf...
متن کاملEffectiveness of Nasal Intermittent Positive Pressure Ventilation versus Nasal Continuous Positive Airway Pressure in Preterm Infants after Less Invasive Surfactant Administration
Background Non-invasive ventilation is increased used in preterm infants. We aimed to compare the effectiveness of nasal intermittent positive pressure ventilation (nIPPV) versus nasal continuous positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS) after less invasive surfactant administration (LISA). Materials and Methods In this clinical trial, eighty ...
متن کاملEarly Nasal Intermittent Positive Pressure Ventilation (NIPPV) versus Nasal Continuous Positive Airway Pressure (NCPAP) for Respiratory Distress Syndrome (RDS) in Infants of 28-36 weeks gestational age: a Randomized Controlled Trial
Background: Early nasal continuous positive airway pressure (NCPAP) has emerged as a primary modality of respiratory support for preterm infants withrespiratory distress syndrome (RDS). However, 30%-40% of these newborns need subsequent mechanical ventilation. Nasal intermittent positive pressure ventilation (NIPPV) is a promising alternative to NCPAP, especially in po...
متن کاملStrategies for the withdrawal of nasal continuous positive airway pressure (NCPAP) in preterm infants.
BACKGROUND While indications for the use of nasal continuous positive airway pressure (NCPAP) and its associated risks and benefits are extensively investigated, the best strategy for the withdrawal of NCPAP remains unknown. In a survey of Australian and New Zealand Neonatologists, 56% stated that their approach to NCPAP weaning was "ad hoc" (Jardine 2008). At what point an infant is considered...
متن کامل