Comparison of NIV-NAVA and NCPAP in facilitating extubation for very preterm infants

Byoung Kook Lee,Seung Han Shin,Ee-Kyung Kim,Han-Suk Kim,Young Hwa Jung

doi:10.1186/s12887-019-1683-4

Abstract

BackgroundVarious types of noninvasive respiratory modalities that lead to successful extubation in preterm infants have been explored. We aimed to compare noninvasive neurally adjusted ventilatory assist (NIV-NAVA) and nasal continuous positive airway pressure (NCPAP) for the postextubation stabilization of preterm infants.MethodsThis retrospective study was divided into two distinct periods, between July 2012 and June 2013 and between July 2013 and June 2014, because NIV-NAVA was applied beginning in July 2013. Preterm infants of less than 30 weeks GA who had been intubated with mechanical ventilation for longer than 24 h and were weaned to NCPAP or NIV-NAVA after extubation were enrolled. Ventilatory variables and extubation failure were compared after weaning to NCPAP or NIV-NAVA. Extubation failure was defined when infants were reintubated within 72 h of extubation.ResultsThere were 14 infants who were weaned to NCPAP during Period I, and 2 infants and 16 infants were weaned to NCPAP and NIV-NAVA, respectively, during Period II. At the time of extubation, there were no differences in the respiratory severity score (NIV-NAVA 1.65 vs. NCPAP 1.95), oxygen saturation index (1.70 vs. 2.09) and steroid use before extubation. Several ventilation parameters at extubation, such as the mean airway pressure, positive end-expiratory pressure, peak inspiratory pressure, and FiO2, were similar between the two groups. SpO2 and pCO2 preceding extubation were comparable. Extubation failure within 72 h after extubation was observed in 6.3% of the NIV-NAVA group and 37.5% of the NCPAP group (P = 0.041).ConclusionsThe data in the present showed promising implications for using NIV-NAVA over NCPAP to facilitate extubation.

Highlights

Various types of noninvasive respiratory modalities that lead to successful extubation in preterm infants have been explored
After excluding infants who had been intubated for greater than 6 weeks, those who were never extubated or died before discharge, and those who were weaned to other modalities, such as heated and humidified high flow nasal cannula (HHHFNC), there were 14 infants who were weaned to nasal continuous positive airway pressure (NCPAP) during Period I and 16 infants who were weaned to NIV-Neurally adjusted ventilatory assist (NAVA) during Period II
At the time of extubation, postmenstrual age (PMA) and weight exhibited no significant differences between the NIV-NAVA group and NCPAP group (30 vs. 29+ 4 weeks and 1045 vs. 1205 g, respectively) (Table 2)

Summary

Introduction

Various types of noninvasive respiratory modalities that lead to successful extubation in preterm infants have been explored. We aimed to compare noninvasive neurally adjusted ventilatory assist (NIV-NAVA) and nasal continuous positive airway pressure (NCPAP) for the postextubation stabilization of preterm infants. Invasive mechanical ventilation (MV) is frequently required in preterm infants after birth to maintain adequate alveolar ventilation and effective gas exchange. Tracheal intubation and MV in preterm neonates can induce ventilator-induced lung injury (VILI) and airway inflammation [1, 2]. Nasal continuous positive airway pressure (NCPAP) maintains functional residual capacity while improving lung compliance and oxygenation. NCPAP has been widely used in the neonatal intensive care unit (NICU) and has proven to be effective in preventing failure of extubation in preterm infants [8].

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