Noninvasive Neurally Adjusted Ventilation in Postextubation Stabilization of Preterm Infants: A Randomized Controlled Study

Abstract

To compare the effects of noninvasive neurally adjusted ventilatory assist (NIV-NAVA) to nasal continuous positive airway pressure (NCPAP) in achieving successful extubation in preterm infants. This prospective, single-center, randomized controlled trial enrolled preterm infants born at <30weeks of gestation who received invasive ventilation. Participants were assigned at random to either NIV-NAVA or NCPAP after their first extubation from invasive ventilation. The primary outcome of the study was extubation failure within 72hours of extubation. Electrical activity of the diaphragm (Edi) values were collected before extubation and at 1, 4, 12, and 24hours after extubation. A total of 78 infants were enrolled, including 35 infants in the NIV-NAVA group and 35 infants in the NCPAP group. Extubation failure within 72hours of extubation was higher in the NCPAP group than in the NIV-NAVA group (28.6% vs 8.6%; P=.031). The duration of respiratory support and incidence of severe bronchopulmonary dysplasia were similar in the 2 groups. Peak and swing Edi values were comparable before and at 1hour after extubation, but values at 4, 12, and 24hours after extubation were lower in the NIV-NAVA group compared with the NCPAP group. In the present trial, NIV-NAVA was more effective than NCPAP in preventing extubation failure in preterm infants. ClinicalTrials.gov: NCT02590757.