Document Detail


A multicenter randomized controlled trial comparing effectiveness of two nasal continuous positive airway pressure devices in very-low-birth-weight infants.
MedLine Citation:
PMID:  21666531     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: Many studies suggest nasal continuous positive airway pressure is an effective and relatively complication-free means of respiratory support in premature infants. However, only limited data exist regarding the practical aspects of nasal continuous positive airway pressure delivery, including the best way to provide the positive airway pressure. DESIGN:: Our aim was to compare the results of treatment using two different nasal continuous positive airway pressure devices: variable flow Infant Flow and constant flow nasal continuous positive airway pressure in two different groups of very-low-birth-weight infants in a multicenter randomized controlled trial. The indication groups were elective to avoid intubation and weaning from mechanical ventilation. SETTING:: Twelve leading tertiary care neonatal centers in Poland. MEASUREMENTS AND MAIN RESULTS:: Among the 276 patients enrolled, 51% infants were randomized to receive Infant Flow and 49% to receive constant flow nasal continuous positive airway pressure. Treatment success (i.e., no need for intubation/reintubation) occurred in 75% of our patients with a nonstatistically significant advantage seen with Infant Flow. The incidence of severe nasal complications and necrotizing enterocolitis were statistically significantly lower in the infants treated with Infant Flow. In our study, factors associated with elective nasal continuous positive airway pressure failure were birth weight ≤1000 g, gestational age ≤28 wks, clinical risk index for babies score >1, and PaO2/Fio2 ratio of <150. Only birth weight ≤1000 g was associated with weaning failure. CONCLUSIONS:: We found fewer severe nasal complications but no statistically significant advantage in treatment success in infants assigned to Infant Flow nasal continuous positive airway pressure compared with those assigned to constant flow nasal continuous positive airway pressure treatment. Significant risk factors of treatment failure include small size, maturity, and severity of respiratory distress syndrome.
Authors:
Klaudiusz Bober; Janusz Swietliński; Jan Zejda; Katarzyna Kornacka; Dorota Pawlik; Jakub Behrendt; Elżbieta Gajewska; Małgorzata Czyżewska; Piotr Korbal; Janusz Witalis; Wojciech Walas; Maria Wilińska; Agnieszka Turzańska; Grzegorz Zieliński; Beata Czeszyńska; Thomas Bachman
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-9
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  -     ISSN:  1529-7535     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Neonatal Intensive Care Unit (KB), Medical University of Silesia, Bytom, Poland; the Department of Scientific Information (JS), The Children's Memorial Health Institute, Warsaw, Poland; the Department of Epidemiology (JZ), Medical University of Silesia, Katowice, Poland; the Department of Neonatology (KK), Medical University Warsaw, Warsaw, Poland; the Department of Neonatology (DP), Medical College Jagiellonian University, Cracow, Poland; the Neonatal Intensive Care Unit (JB), Medical University of Silesia, Clinical Hospital No. 1, Zabrze, Poland; the Department of Neonatology (EG, MC), Medical University Wrocław, Wrocław, Poland; the Neonatal Intensive Care Unit (PK), Regional Hospital No. 2, Bydgoszcz, Poland; the Neonatal Intensive Care Unit (JW), Regional Hospital, Rzeszów, Poland; the Department of Anesthesiology & Intensive Care (WW), Regional Hospital, Opole, Poland; the Department of Neonatology (MW, AT), Center of Medical Postgraduate Education, Warsaw, Poland; the Neonatal Intensive Care Unit (GZ), Regional Hospital, Częstochowa, Poland; the Department of Neonatology (BC), Pomeranian Medical University, Clinical Hospital No. 1, Szczecin, Poland; and the Administration (TB), Mountains Community Hospital, Lake Arrowhead, CA.
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