Presented at the Neonatal Society 2006 Spring Meeting.
Singh SD1, Robinson MJ1, Clarke P1, Bowe L1, Smith J2, Glover K3, Pasquill A4
1 NICU, Hope Hospital, Stott Lane, Salford, United Kingdom
2 NICU, Panorama Hospital, Cape Town, South Africa
3 NICU, Royal Albert Edward Infirmary, Wigan, United Kingdom
4 NICU, Royal Bolton Hospital, Bolton, United Kingdom
Background: Nasal CPAP (nCPAP) is currently used after extubation from mechanical ventilation. There is, however, uncertainty regarding the best approach to nCPAP weaning.
Objective: To determine whether reduction of pressure (‘pressure’) is more effective than alternating periods of nCPAP with nasal cannula low flow oxygen (‘time off’) in weaning very low birthweight (VLBW) infants from nCPAP.
Design/Methods: Infants <1500g, and stable in <0.3 FIO2 on nCPAP were randomised to a weaning strategy of either gradual reduction of nCPAP ‘pressure’, or increasing duration of ‘time off’ nCPAP. Infants were considered successfully weaned if stable off nCPAP for 7 days.
Results: Median (IQR) birth weights and gestations were: ‘pressure’ group, 937g (809 – 1142g) and 27 (26 -29) wks; ‘time off’ group, 1020g (788 – 1260g) and 28 (27 – 29) wks. Of 105 eligible infants, 36 (65%) infants in the ‘pressure’ and 21 (37%) in the ‘time off’ arms successfully weaned (p=0.006) [95% CI 0.10 – 0.46]. Infants allocated to the ‘pressure’ arm weaned faster and spent significantly fewer days on nCPAP.
Conclusion: For VLBW infants, gradual reduction in nCPAP pressure may facilitate more rapid respiratory weaning compared with periods of increasing time spent off nCPAP.