Browsing by Author "BANCALARI, A"

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    DOES CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DURING WEANING FROM INTERMITTENT MANDATORY VENTILATION IN VERY-LOW-BIRTH-WEIGHT INFANTS HAVE RISKS OR BENEFITS - A CONTROLLED TRIAL
    (1995) TAPIA, JL; BANCALARI, A; GONZALEZ, A; MERCADO, ME
    Objective: The purpose of this study was to evaluate three ventilator weaning strategies and to evaluate whether the use of continuous positive airway pressure (CPAP) via a nasopharyngeal or endotracheal tube would increase the likelihood of extubation failure in very low birth weight (VLBW) infants. Study design: We studied prospectively 87 preterm infants (mean +/- SD; birth weight: 1078 +/- 188 g; gestational age: 28.8 +/- 2.2 weeks) who were in the process of being weaned from intermittent mandatory ventilation (IMV). Infants were assigned by systematic sampling to one of the following three treatment groups: (1) direct extubation from IMV (D.EXT) (n=30); (2) preextubation endotracheal CPAP (ET-CPAP) for 12-24 hr (n=28); or (3) postextubation nasopharyngeal CPAP (NP-CPAP) for 12-24 hr (n=29). Failure was defined as the need for resumption of mechanical ventilation within 72 hr of extubation due to frequent or severe apnea and/or respiratory failure (pH < 7.25, PaCO2 > 60 mm Hg, and/or requirement for oxygen FiO(2) > 60%). Results: There were no significant differences in failure rates among the three procedures. Failures were 2/30 (7%) in D.EXT; 4/28 (14%) in ET-CPAP; and 7/29 (24%) in the NP-CPAP. There were also no differences in FiO(2), PaO2, and respiratory rates before and after discontinuation of IMV among the three groups. PaCO2 values were slightly higher in the NP-CPAP group 12-24 hr after weaning from IMV. Conclusion: We were unable to demonstrate a clear difference in extubation outcome by use of CPAP administered via an endotracheal or nasopharyngeal tube when compared to direct extubation from low-rate IMV in VLBW infants. (C) 1995 Wiley-Liss, Inc.