Bubble vs conventional continuous positive airway pressure for prevention of extubation failure in preterm very low birth weight infants: A pilot study

Abstract

Objective: To compare the efficacy of bubble and conventional nasal continuous positive airway pressure (CPAP) in preventing extubation failure (EF) in preterm infants. Methods: Infants of gestation ≤32 wk and birth weight < 1500 g, ready for initial extubation within first wk of life were randomly allocated to either bubble (n = 16) or conventional (n = 16) CPAP. A standardized protocol was used for extubation. Bubble CPAP was delivered by Fischer and Paykel equipment using short binasal prongs and conventional CPAP was delivered by a ventilator using Argyle short binasal prongs. CPAP was initiated at a pressure of 4–6 cm of H₂O and FiO₂ of 0.4–0.5 and adjusted to maintain normal saturation (90–93%) and comfortable breathing. Primary outcome was EF, defined as need for mechanical ventilation within 72 h of extubation. Results: Baseline characteristics including birth weight (g; 1027 ± 243 vs. 1018 ± 227; p = 0.83), gestation (wk; 28.7 ± 1.8 vs. 28.4 ± 1.6; p = 0.30), infants < 28 wk gestation (6 vs. 7, p = 0.72) were comparable between the two groups. Respiratory distress syndrome was the indication for ventilation in 13 (81%) and 14 (87%) infants on bubble CPAP and conventional CPAP groups respectively. (p = 0.99). There was no difference in the EF rates between the bubble (n = 4) and conventional CPAP (n = 9) groups. (RR 0.49; 95% CI 0.20–1.2; p = 0.14). Median time to extubation failure was also comparable between the two groups (h; median [range]: 29 [14–49] vs. 17 [7–28]; p = 0.35). Conclusions: The possibility that bubble CPAP may be associated with reduced EF as suggested in this pilot study requires further investigation in an adequately powered multicentric study.