title: Bubble vs conventional continuous positive airway pressure for prevention of extubation failure in preterm very low birth weight infants: a pilot study.
abstract: OBJECTIVE
  To compare the efficacy of bubble and conventional nasal continuous positive airway pressure (CPAP) in preventing extubation failure (EF) in preterm infants.
  
  
  METHODS
  Infants of gestation ≤32 wk and birth weight <1500 g, ready for initial extubation within first wk of life were randomly allocated to either bubble (n = 16) or conventional (n = 16) CPAP. A standardized protocol was used for extubation. Bubble CPAP was delivered by Fischer and Paykel equipment using short binasal prongs and conventional CPAP was delivered by a ventilator using Argyle short binasal prongs. CPAP was initiated at a pressure of 4-6 cm of H(2)O and FiO(2) of 0.4-0.5 and adjusted to maintain normal saturation (90-93%) and comfortable breathing. Primary outcome was EF, defined as need for mechanical ventilation within 72 h of extubation.
  
  
  RESULTS
  Baseline characteristics including birth weight (g; 1027 ± 243 vs. 1018 ± 227; p = 0.83), gestation (wk; 28.7 ± 1.8 vs. 28.4 ± 1.6; p = 0.30), infants <28 wk gestation (6 vs. 7, p = 0.72) were comparable between the two groups. Respiratory distress syndrome was the indication for ventilation in 13 (81%) and 14 (87%) infants on bubble CPAP and conventional CPAP groups respectively. (p = 0.99). There was no difference in the EF rates between the bubble (n = 4) and conventional CPAP (n = 9) groups. (RR 0.49; 95% CI 0.20-1.2; p = 0.14). Median time to extubation failure was also comparable between the two groups (h; median [range]: 29 [14-49] vs. 17 [7-28]; p = 0.35).
  
  
  CONCLUSIONS
  The possibility that bubble CPAP may be associated with reduced EF as suggested in this pilot study requires further investigation in an adequately powered multicentric study.
authors.affiliation: Department of Pediatrics WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sucheta
authors.initials: S
authors.lastname: Yadav
authors.forename: Anu
authors.initials: A
authors.lastname: Thukral
authors.forename: M Jeeva
authors.initials: MJ
authors.lastname: Sankar
authors.forename: V
authors.initials: V
authors.lastname: Sreenivas
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Deorari
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Paul
authors.forename: Ramesh
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D060666:Airway Extubation / Q000379:methods*; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D010865:Pilot Projects; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D016896:Treatment Outcome