Randomised trial of elective continuous positive airway pressure (CPAP) compared with rescue CPAP after extubation
Department of Child
Health St George's Hospital Medical School
London
Correspondence to: Dr Nicola Robertson Department of Paediatrics Hammersmith Hospital Imperial College School of Medicine London W12 OHS.
Accepted 14 January
1998
AIM
To determine if a
weaning regimen on flow driver continuous positive airway pressure
(CPAP) would decrease the number of ventilator days but increase the
number of CPAP days when compared with a rescue regimen.
METHODSFifty eight
babies of 24-32 weeks gestation with respiratory distress syndrome
(RDS) were studied prospectively. After extubation they were randomly
allocated to receive CPAP for 72 hours (n=29) according to a weaning
regimen, or were placed in headbox oxygen and received CPAP only if
preset "start CPAP" criteria were met (n=29, rescue group).
RESULTSThere was no
difference in successful extubation at 72 hours, 1 and 2 weeks, between
the groups in terms of the number of reventilation episodes,
reventilation days, or in total days of CPAP. Birthweight, gestational
age, race, day of first extubation, antenatal or postnatal steroids,
patent ductus arteriosus status and maximal mean airway pressure used
were of no value in predicting success or failure at 72 hours, 1, or 2 weeks.
CONCLUSIONThe weaning
regimen did not decrease the number of ventilator days or days on CPAP
compared with the rescue regimen. The rescue regimen on flow driver
CPAP seems to be a safe and effective method of managing a baby of
24-32 weeks gestation who has been ventilated for RDS or immature lung disease.
© 1998 by Archives of Disease in Childhood
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