Unsynchronized Nasal Intermittent Positive Pressure Ventilation to Prevent Extubation Failure in Neonates: A Randomized Controlled Trial

Abstract

To evaluate the role of Unsynchronized Nasal Intermittent Positive Pressure Ventilation (NIPPV) in prevention of extubation failure in mechanically ventilated preterm neonates weighing less than 2,000 g. This randomized controlled trial was conducted in the neonatal intensive care unit of a tertiary care teaching hospital. Preterm neonates weighing less than 2,000 g, mechanically ventilated for more than 24 h were included after extubation. Neonates were randomized into two groups. Group 1 was given unsynchronized nasal intermittent positive pressure ventilation with shortened endotracheal tube by ventilator and Group 2 was given head box oxygen, fraction of oxygen in inspired air was 50%. Primary outcome variable was rate of extubation failure within 72 h of extubation. Birth weight, gestational age, age at intubation, indication for mechanical ventilation and antenatal details were comparable in the two groups. Extubation failure rate was 16% in Group 1 vs 63% in Group 2 (RR = 0.25; 95% CI: 0.12, 0.51, p value = 0.00), that is a reduction of 47%. Unsynchronized nasal intermittent positive pressure ventilation did not have any serious side effects, however it did not reduce total hospital stay. Unsynchronized Nasal Intermittent Positive Pressure Ventilation is a simple technique of noninvasive ventilation which significantly reduces the rate of extubation failure in preterm neonates and is not associated with serious side effects.