Bubble-CPAP vs. Ventilatory-CPAP in Preterm Infants with Respiratory Distress

Bahareh Bahman-Bijari, Arash Malekiyan, Pedram Niknafs, Mohammad-Reza Baneshi, Bahareh Bahman-Bijari, Arash Malekiyan, Pedram Niknafs, Mohammad-Reza Baneshi

Abstract

Objective: Application of Continuous Positive Airway Pressure (CPAP) in neonate with respiratory distress is associated with reduction of respiratory failure, reduced complications and mortality. Bubble CPAP (B-CPAP) and ventilator-derived CPAP (V-CPAP) are two most popular CPAP modes. We aimed to determine whether B-CPAP and V-CPAP would have different survival rate and possible complications.

Methods: This prospective clinical trial was performed on 50 preterm neonates weighing 1000-2000 gr who were admitted to the neonatal intensive care unit of Afzalipoor Hospital because of respiratory distress between June 2009 and May 2010. Patients were randomly allocated into treatment groups using minimization technique. Survival analysis was applied to estimate and compare survival rates. Duration of oxygen therapy, hospital stay as well as hospitalization costs were compared using independent sample t-test.

Findings: Estimated survival rates at 24 hours in B-CPAP and V-CPAP groups were 100% and 77% respectively. Corresponding figures at 48 hours were 100% and 71%. In addition the hospitalization cost in V-CPAP group was significantly higher than in B-CPAP group.

Conclusion: According to our results, B-CPAP was effective in the treatment of neonates who were suffering from respiratory distress and reduced the duration of hospital stay. In addition to mentioned benefits, its low cost may be the reason to use B-CPAP broadly compared with V-CPAP.

Keywords: Bubble CPAP; Continuous Positive Airway Pressure; Respiratory Distress; Ventilator-derived CPAP.

Figures

Fig. 1
Fig. 1
Survival rate of neonates in B-CPAP (top line) and V-CPAP (bottom line)

References

    1. Chami M, Geoffray A. Pulmonary sequelae of prematurity: radiological manifestations. Pediatr Pulmonol Suppl. 1997;16:51.
    1. Chye JK, Gray PH. Rehospitalization and growth of infants with bronchopulmonary dysplasia: a matched control study. J Paediatr Child Health. 1995;31(2):105–11.
    1. Collaborative UK, Trial Group. ECMO. UK collaborative randomized trial of neonatal extracorporeal membrane oxygenation. Lancet. 1996;348(9020):75–82.
    1. Economic outcome for intensive care of infants of birthweight 500–999 g born in Victoria in the post surfactant era. The Victorian Infant Collaborative Study Group. J Paediatr Child Health. 1997;33(3):202–8.
    1. Vaucher YE, Dudell GG, Bejar R, Gist K. Predictors of early childhood outcome in candidates for extracorporeal membrane oxygenation. J Pediatr. 1996;128(1):109–17.
    1. Walsh-Sukys MC, Bauer RE, Cornell DJ, et al. Severe respiratory failure in neonates: mortality and morbidity rates and neurodevelopmental outcomes. J Pediatr. 1994;125(1):104–10.
    1. Greenough A. Neonatal chronic lung disease and exogenous surfactant therapy. Eur J Pediatr. 1998;157(Suppl 1):S16–8.
    1. Jobe AH. Pulmonary surfactant therapy. N Engl J Med. 1993;328(12):861–8.
    1. Guyer B, MacDorman MF, Martin JA, et al. Annual summary of vital statistics-1997. Pediatrics. 1998;102(6):1333–49.
    1. Hertz-Picciotto I, Din-Dzietham R. Comparisons of infant mortality using a percentile-based method of standardization for birthweight or gestational age. Epidemiology. 1998;9(1):61–7.
    1. Menard MK, Liu Q, Holgren EA, Sappenfield WM. Neonatal mortality for very low birth weight deliveries in South Carolina by level of hospital perinatal service. Am J Obstet Gynecol. 1998;179(2):374–81.
    1. Dooley SL, Freels SA, Turnock BJ. Quality assessment of perinatal regionalization by multivariate analysis: Illinois, 1991–1993. Obstet Gynecol. 1997;89(2):193–8.
    1. Angus DC, Linde-Zwirble WT, Clermont G, et al. Epidemiology of neonatal respiratory failure in the United States. Am J Respir Crit Care Med. 2001;164(7):1154–60.
    1. Davis PG, Morley CJ, Owen LS. Non-invasive respiratory support of preterm neonates with respiratory distress: Continuous positive airway pressure and nasal intermittent positive pressure ventilation. Sem Fetal Neonatal Med. 2009;14(1):14–20.
    1. Mazella M, Bellini C, Calevo MG, et al. A randomized control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2001;85(2):86–90.
    1. Morley CJ, Davis PG, Doyle LW, et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358(7):700–8.
    1. Finer NN, Carlo WA, Duara S, et al. Delivery room continuous positive airway pressure/positive end-expiratory pressure in extremely low birth weight infants: a feasibility trial. Pediatrics. 2004;114(3):651–7.
    1. Gregory GA, Kitterman JA, Phibbs RH, et al. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 1971;284(24):1333–40.
    1. Lee KS, Dunn MS, Fenwick M, Shennan AT. A comparison of underwater bubble continuous positive airway pressure with ventilator-derived continuous positive airway pressure in premature neonates ready for extubation. Biol Neonate. 1998;73(2):69–75.
    1. Narendran V, Donovan EF, Hoath SB, et al. Comparison between early bubble CPAP and conventional CPAP in reducing the incidence of chronic lung disease. Pediatr Res. 2002;51:337A. [abstract]
    1. Nowadzky T, Pantoja A, Britton JR. Bubble Continuous Positive Airway Pressure, A potentially better practice, reduces the use of mechanical ventilation among very low birth weight infants With respiratory distress syndrome. Pediatrics. 2009;123(6):1534–40.
    1. Bryan AC, Froese AB. Reflections on the HIFI trial. Pediatrics. 1991;87(4):565–7.
    1. Keszler M. INSURE, Infant Flow, Positive Pressure and Volume Guarantee-Tell us what is best: Selection of respiratory support modalities in the NICU. Early Hum Dev. 2009;85(10 Suppl):S53–6.
    1. Wiswell Th, Srinivasan P. Continuous Positive Airway Pressure. In: Goldsmith JP, Karotkin EH, editors. Assisted ventilation of the neonate. 3rd ed. Philadelphia: Sunders; 2003. pp. 127–43.
    1. Martin RJ, Fanaroff AA, Walsh Mc, Jobe AH. Assisted ventilation and its complications of respiratory distress. In: Fanaroff RR, Martin RJ, editors. Neonatal–perinatal Medicine. 8th ed. Philadelphia: Mosby; 2006. pp. 1100–12.
    1. Urs PS, Khan F, Maiya PP. Bubble CPAP-A primary respiratory support for respiratory distress syndrome in newborns. Ind Pediatr. 2009;46(5):409–11.
    1. Kugelman A, Feferkorn I, Riskin R, et al. Nasal Intermittent Mandatory Ventilation versus Nasal Continuous Positive Airway Pressure for respiratory distress syndrome: A Randomized, controlled, prospective study. J Pediatr. 2007;150(5):521–6.
    1. Tagare A, Kadam S, Vaidya U, et al. A pilot study of comparison of BCPAP vs. VCPAP in preterm infants with early onset respiratory distress. J Trop Pediatr. 2010;56(3):191–4.
    1. Morley CJ, Lau R, De Paoli A, et al. Nasal continuous positive airway pressure: does bubbling improve gas exchange? Arch Dis Child Fetal Neonatal Ed. 2005;90(4):F343–4.
    1. Pillow JJ, Hillman N, Moss TJM, et al. Bubble continuous positive airway pressure enhances lung volume and gas exchange in preterm lambs. Am J Respir Crit Care Med. 2007;176(1):63–9.
    1. Ammari A, Suri M, Milisavljevic V, et al. Variables associated with the early failure of nasal CPAP in very low birth weight infants. Newborn and Infant Nursing Reviews. 2006;6(2):68–75.
    1. Koti J, Murki S, Gaddam P, et al. Bubble CPAP for respiratory distress syndrome in preterm infants. Indian Pediatrics. 2010;47(2):139–43.
    1. Nekvasil R, Kratky J, Penkova Z, Stejskal J. High frequency “bubble” oscillation ventilation in the neonatal period. Cesk Pediatr. 1992;47:465–70. (In Czech)
    1. Lucking SE, Fields AI, Mahfood S, et al. High-frequency ventilation versus conventional ventilation in dogs with right ventricular dysfunction. Crit Care Med. 1986;14(9):798–801.
    1. Chiaranda M, Rubini A, Fiore G, et al. Hemodynamic effects of continuous positive-pressure ventilation and high-frequency jet ventilation with positive end-expiratory pressure in normal dogs. Crit Care Med. 1984;12(9):750–4.
    1. Huang WC, Hua YM, Lee CM, et al. Comparison between Bubble CPAP and Ventilator-derived CPAP in rabbits. Pediatr Neonatol. 2008;49(6):223–9.
    1. Wung JT, Driscoll JM, Epstein RA, et al. A new device for CPAP by nasal route. Crit Care Med. 1975;3(2):76–8.
    1. Wung JT, Koons AH, Driscoll JM, James LS. Changing incidence of bronchopulmonary dysplasia. J Pediatr. 1979;95(5 pt 2):845–7.
    1. Avery ME, Tooley WH, Keller JB, et al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics. 1987;79(1):26–30.
    1. De Klerk AM, De Klerk RK. Nasal continuous positive airway pressure and outcomes of preterm infants. J Paediatr Child Health. 2001;37(2):161–7.
    1. Van Marter LJ, Allred EN, Pagano M, et al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network. Pediatrics. 2000;105(6):1194–201.
    1. Polin RA, Sahni R. Newer experience with CPAP. Semin Neonatal. 2002;7(5):379–89.
    1. Koyamaibole L, Kado J, Qovu JD, et al. An evaluation of bubble-CPAP in a neonatal unit in a developing country: effective respiratory support that can be applied by nurses. J Trop Pediatr. 2006;52(4):249–53.
    1. Pieper CH, Smith J, Maree D, Pohl FC. Is nCPAP of value in extreme preterms with no access to neonatal intensive care? J Trop Pediatr. 2003;49(3):148–52.

Source: PubMed

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