title: Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome.
abstract: OBJECTIVE
  We hypothesised that short-term application of bi-level nasal continuous positive airway pressure CPAP (SiPAP) compared with conventional nasal CPAP (nCPAP) at the same mean airway pressure in infants with persistent oxygen need recovering from respiratory distress syndrome would improve CO2 removal with no change in oxygen requirement.
  
  
  METHODS
  Non-blinded, randomised, observational four-period crossover study.
  
  
  METHODS
  Level III NICU; low-birthweight infants requiring CPAP and oxygen while recovering from respiratory distress syndrome.
  
  
  METHODS
  Infants requiring nasal CPAP for >24 h prior to study enrolment, and fraction of inspired oxygen requirement (FiO2) of 0.25-0.5, were randomised to either nCPAP or SiPAP. A crossover design with four 1 h treatment periods was used such that each infant received both treatments twice. Oxygen saturations (SaO2), transcutaneous CO2 (tcCO2) and vital signs were monitored continuously. Polysomnographic recordings were analysed for apnoea, bradycardia and oxygen desaturation.
  
  
  RESULTS
  Twenty low-birthweight infants receiving 0.3±0.04% supplemental oxygen on CPAP of 6 cm H2O were studied at an average of 33 days of age (±23 days, SD). There were no differences in tcCO2 or other physiological parameters except mean blood pressure, which was lower during nCPAP (52.3±8.3 vs 54.4±9.1 mm Hg; ±SD; p<0.01). No differences in short or prolonged apnoea, bradycardia or significant desaturation events were observed.
  
  
  CONCLUSIONS
  At similar mean airway pressures, SiPAP does not improve CO2 removal, oxygenation or other studied physiological parameters with the exception of mean blood pressure, which was not clinically significant.
  
  
  BACKGROUND
  NCT01053455.
authors.affiliation: Infant Diagnostic & Research Center, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota, USA Department of Pediatrics-Neonatology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Lampland
authors.affiliation: Infant Diagnostic & Research Center, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Plumm
authors.affiliation: Infant Diagnostic & Research Center, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Worwa
authors.affiliation: Infant Diagnostic & Research Center, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Meyers
authors.affiliation: Infant Diagnostic & Research Center, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota, USA Department of Pediatrics-Neonatology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Mammel
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D001919:Bradycardia / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure / Q000379:methods; D018592:Cross-Over Studies; D011659:Pulmonary Gas Exchange; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy
keywords: CPAP; Neonatology; Respiratory