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a Department of
Paediatrics, Royal Women's Hospital, Melbourne, Victoria, Australia, b University of Melbourne, Victoria, Australia
Correspondence to: Dr Peter Davis Royal Women's Hospital 132 Grattan Street, Carlton, Victoria 3053, Australia. Email: peter_davis.obgyn_rwh{at}muwaye.unimelb.edu.au
Accepted 4 November
1997
AIM
To determine
whether extubation to nasal continuous airway pressure (NCPAP) results
in a greater proportion of infants remaining free of additional
ventilatory support for one week after extubation compared with those
extubated directly to headbox oxygen.
METHODSA randomised,
controlled, clinical trial was conducted at the neonatal intensive care
unit of the Royal Women's Hospital, Melbourne, of infants with
birthweights between 600 and 1250 g, ventilated via an endotracheal
tube for more than 12 hours, requiring less than 50% oxygen, a
ventilator rate 
20/minute, considered by the clinical management
team to be ready for extubation. Infants were randomly allocated either
to NCPAP or to oxygen administered via a headbox. Success was defined
by no requirement for additional ventilatory support over the week
following extubation. Failure criteria were (i) apnoea; (ii) absolute
increase in oxygen requirement greater than 15% above that required
before extubation; or (iii) respiratory acidosis (pH<7.25 with
pCO2 >6.67 kPa).
RESULTSThirty one of
47 (66%) infants were successfully extubated to NCPAP compared with 18 of 45 (40%) for headbox oxygen. The increase in failure rate in the
headbox group was due primarily to increased oxygen requirements in
this group. Of the 27 who failed headbox oxygen, 26 were given a trial
of NCPAP and 13 did not require endotracheal reintubation. There was no
significant difference between the groups in the total number of days
of assisted ventilation or the duration of inpatient stay.
CONCLUSIONSNCPAP
applied prophylactically after endotracheal extubation reduces the
incidence of adverse clinical events that lead to failure of extubation
in the seven days after extubation. This reduction is clinically
important. The benefits of NCPAP do not seem to be associated with an
increased incidence of unwanted side effects.
This article has been cited by other articles:
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  B. M. Stefanescu, W. P. Murphy, B. J. Hansell, M. Fuloria, T. M. Morgan, and J. L. Aschner A Randomized, Controlled Trial Comparing Two Different Continuous Positive Airway Pressure Systems for the Successful Extubation of Extremely Low Birth Weight Infants Pediatrics, November 1, 2003; 112(5): 1031 - 1038. [Abstract] [Full Text] [PDF]
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P. J. Sharek, R. Baker, F. Litman, J. Kaempf, K. Burch, E. Schwarz, S. Sun, and N. R. Payne Evaluation and Development of Potentially Better Practices to Prevent Chronic Lung Disease and Reduce Lung Injury in Neonates Pediatrics, April 1, 2003; 111(4): e426 - 431. [Abstract] [Full Text] [PDF]
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J. K. Jackson, J. Vellucci, P. Johnson, and H. W. Kilbride Evidence-Based Approach to Change in Clinical Practice: Introduction of Expanded Nasal Continuous Positive Airway Pressure Use in an Intensive Care Nursery Pediatrics, April 1, 2003; 111(4): e542 - 547. [Abstract] [Full Text] [PDF]
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 P Davis, M Davies, and B Faber A randomised controlled trial of two methods of delivering nasal continuous positive airway pressure after extubation to infants weighing less than 1000 g: binasal (Hudson) versus single nasal prongs Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2001; 85(2): F82 - 85. [Abstract] [Full Text] [PDF]
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