A study on comparison of nasal cpap vs nippv in preterm with respiratory distress syndrome as post extubation support

Objective: Nasal continuous positive airway pressure (NCPAP) is a useful method of respiratory support after extubation. However, some infants fail despite CPAP use and require reintubation. Recent evidence shows that synchronized nasal intermittent positive pressure ventilation (NIPPV) may decrease extubation failure in preterm infants. Our aim was to evaluate whether NIPPV decreases extubation failure compared with CPAP in preterm with respiratory distress syndrome (RDS) post extubation. Methods: Infants who were less than 37 weeks gestation ageor less than 1.8kg and who were mechanically ventilated for RDS in the first 7 days were extubated to either NIPPV or NCPAP afterextubation. The criteria for extubation were peak inspiratory pressure of ≤16 cm H2O, positive end expiratory pressure of ≤5 cm H2O, intermittent mandatory ventilation rate of 15 to 25, and fraction of inspired oxygen ≤0.30.Primary outcome was extubation failure and need for reintubation. Secondary outcomes included mean duration of non-invasive ventilation and mechanical ventilation after extubation, duration of hospital stay and mortality. Results: Seventeen (31.4%) of 54 infants required reintubation with the use of NIPPV versus 20(36.3%) of 55infants,with the use of CPAP (P=0.54). Themean duration of mechanical ventilation in NIPPV group was 1.63 days which was less than mean duration of mechanical ventilation of 1.96 days in CPAP group but the difference was not statistically significant (p=0.147). Similarly mean duration of non-invasive ventilation in NIPPV group was 3.01 days which was less than mean duration of non-invasive ventilation of 3.01 days in CPAP group but the difference was not statistically significant (p=0.081) . Six (11.1%) out of 54 patients in NIPPV died compared to 8 (14.54%) patients in CPAP group (p=0.58). There was no significant difference in duration of hospital stay (14.19 days in NIPPV group vs 14.96 days in CPAP group ; p=0.58). Conclusions: NIPPV did not decrease the rates of extubation failure after mechanical ventilation in preterm babies with RDS compared with NCPAP.