A Randomized, Controlled Trial Comparing Two Different Continuous Positive Airway Pressure Systems for the Successful Extubation of Extremely Low Birth Weight Infants

Beatrice M. Stefanescu, W. Paul Murphy, Brenda J. Hansell, Mamta Fuloria, Timothy M. Morgan, Judy L. Aschner

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Objective. To determine whether the use of the Infant Flow continuous positive airway pressure (IF CPAP) system reduces the rate of extubation failure among extremely low birth weight (ELBW) infants (infants with birth weight <1000 g) when compared with conventional CPAP delivered with a conventional ventilator and nasal prongs. Methods. A prospective, unmasked, randomized, controlled clinical trial was conducted in 162 eligible intubated ELBW infants who were hospitalized in 2 intensive care nurseries in Winston-Salem, North Carolina, between July 1997 and November 2000. Successful extubation was defined as no need for reintubation for any reason for at least 7 days after the first extubation attempt. Results. The individual extubation success rates were 61.9% (52 of 84) in the conventional CPAP group and 61.5% (48 of 78) in the IF CPAP group. There were no significant differences in the extubation success rate in any birth weight subset between the 2 cohorts. The most common cause of extubation failure was apnea/bradycardia. Infants who were randomized to IF CPAP had fewer days on supplemental O2 and shorter hospital stays. Conclusions. Extubation failure is a common problem, occurring in nearly 40% of ELBW infants who require mechanical ventilation. IF CPAP was as effective but no more effective than conventional CPAP in preventing extubation failure among ELBW infants. New strategies are needed to identify predictors of extubation success and to treat apnea/bradycardia, the most common cause of extubation failure, thereby reducing the likelihood of prolonged intubation in this high-risk cohort of premature infants.

Original languageEnglish (US)
Pages (from-to)1031-1038
Number of pages8
JournalPediatrics
Volume112
Issue number5
DOIs
StatePublished - Nov 2003
Externally publishedYes

Fingerprint

Extremely Low Birth Weight Infant
Continuous Positive Airway Pressure
Randomized Controlled Trials
Apnea
Bradycardia
Birth Weight
Nurseries
Mechanical Ventilators
Critical Care
Nose
Artificial Respiration
Intubation
Premature Infants
Length of Stay

Keywords

  • Continuous positive airway pressure
  • Extremely low birth weight
  • Extubation
  • Infant Flow CPAP

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

A Randomized, Controlled Trial Comparing Two Different Continuous Positive Airway Pressure Systems for the Successful Extubation of Extremely Low Birth Weight Infants. / Stefanescu, Beatrice M.; Murphy, W. Paul; Hansell, Brenda J.; Fuloria, Mamta; Morgan, Timothy M.; Aschner, Judy L.

In: Pediatrics, Vol. 112, No. 5, 11.2003, p. 1031-1038.

Research output: Contribution to journalArticle

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abstract = "Objective. To determine whether the use of the Infant Flow continuous positive airway pressure (IF CPAP) system reduces the rate of extubation failure among extremely low birth weight (ELBW) infants (infants with birth weight <1000 g) when compared with conventional CPAP delivered with a conventional ventilator and nasal prongs. Methods. A prospective, unmasked, randomized, controlled clinical trial was conducted in 162 eligible intubated ELBW infants who were hospitalized in 2 intensive care nurseries in Winston-Salem, North Carolina, between July 1997 and November 2000. Successful extubation was defined as no need for reintubation for any reason for at least 7 days after the first extubation attempt. Results. The individual extubation success rates were 61.9{\%} (52 of 84) in the conventional CPAP group and 61.5{\%} (48 of 78) in the IF CPAP group. There were no significant differences in the extubation success rate in any birth weight subset between the 2 cohorts. The most common cause of extubation failure was apnea/bradycardia. Infants who were randomized to IF CPAP had fewer days on supplemental O2 and shorter hospital stays. Conclusions. Extubation failure is a common problem, occurring in nearly 40{\%} of ELBW infants who require mechanical ventilation. IF CPAP was as effective but no more effective than conventional CPAP in preventing extubation failure among ELBW infants. New strategies are needed to identify predictors of extubation success and to treat apnea/bradycardia, the most common cause of extubation failure, thereby reducing the likelihood of prolonged intubation in this high-risk cohort of premature infants.",
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