Increased positive continuous airway pressure after extubation of extremely preterm infants significantly improved outcomes. The frequency of undesirable effects did not increase.
Scientists from the university and several specialist centers in Australia assessed the effectiveness and safety of increased positive continuous airway pressure (CPAP) for mechanical ventilation after extubation of extremely preterm infants compared with standard pressure levels in the first seven days of life. The study results were published in The Lancet: Child & Adolescent Health.
|Data from 130 extremely preterm infants who were mechanically ventilated via an endotracheal tube and first extubated using CPAP were analyzed. The average gestational age at birth was approximately 26 weeks, and the average birth weight was 777 g. All children were treated with exogenous surfactant and caffeine before the study began. Participants were evenly distributed into two groups: increased (9–11 cm H2O) and standard (6-8 cm H2O) pressure.
Extubation failure was recorded in 35% in the high-pressure group and in 57% in the standard-pressure group. Increasing airway pressure reduced the risk of extubation failure by almost 22%.
There were no significant differences in the incidence of adverse events between groups at seven days of follow-up. Three children died: two in the high blood pressure group and one in the standard group. Pneumothorax was reported with a uniformly low frequency. The rate of spontaneous bowel perforation was also comparable, with two participants in the high-pressure group and one in the standard-pressure group. No cases of interstitial pulmonary emphysema were observed.