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CPAP weaning method: Effect on length of wean, oxygen duration and hospital stay?

Presented at the Neonatal Society 2010 Summer Meeting.

Todd DA1,2, Broom M1, Shabolt B2,3, Wright A4, Cameron C4, Rochefort M4, Jardine L5

1 Centre for Newborn Care (CNC), Canberra, ACT, Australia
2 ANU Medical School, Canberra, ACT, Australia
3 Epidemiology, Canberra Hospital, Canberra, ACT, Australia
4 CNC, Westmead Hospital, Westmead, NSW, Australia
5 CNC, Royal Brisbane & Women’s Hospital, QLD, Australia

Background: Continuous positive airway pressure (CPAP) has been a recognised form of respiratory support for over 30 years. Previous to the “CPAP Weaning Trial” minimal evidence has been available supporting the optimum method of weaning premature babies (PBs) “OFF” CPAP. 

Aim: The CPAP Weaning Trial compared three commonly used weaning methods and their impact on length of wean (LOW), oxygen duration (OD) including chronic lung disease (CLD –oxygen requirement at 36 weeks post conceptual age)and length of stay (LOS).

Methods: Since 2006 this multi-centre RCT has randomised PBs <30 weeks gestational age (GA) into one of the three CPAP weaning methods (M) once they had reached the trial “stability criteria”.

M1: PB taken “OFF” CPAP with the view to stay “OFF” but if fails to stay “OFF” having met the “failure criteria”, a further 48 hours “ON” CPAP is required before coming “OFF” again,

M2: PB weaned gradually “OFF” CPAP by increasing length of time “OFF” (max increase of 2 hours) alternating with fixed periods of 6 hours “ON” CPAP,

M3: As with M2, PB gradually weaned “OFF” CPAP but during “OFF” periods is supported with 2 mm nasal cannula at a flow 0.5 L/min.

Results: Currently 154 PBs have completed the trial (table).

Using generalised linear models, chi square and Bonferroni pair wise comparisons (SPSS 17), the CPAP weaning method was analysed in relation to LOW, OD, CLD and LOS.

CPAP weaning method: Effect on length of wean, oxygen duration and hospital stay?

# Mean ±1SD, ## Estimated marginal means ±1SE, * Significantly longer than M1 p<0.001

Conclusion: Using the stability and failure criteria of the trial, CPAP weaning using “M1” significantly reduces LOW, OD, CLD and LOS.

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