Randomised controlled trial of weaning strategies for preterm infants on nasal continuous positive airway pressure

BMC Pediatrics

David Andrew Osborn²  Sue Oliver¹  Girvan Malcolm²  Tracey Lutz²  Shelley Reid³  Jessica Tang⁴ 

[1] RPA Newborn Care, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney NSW 2050, Australia;Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney NSW 2006, Australia;Faculty of Nursing and Midwifery, University of Sydney, Sydney NSW 2006, Australia;University of Melbourne, Melbourne, Australia

关键词: Premature;    Infant;    Ventilator weaning;    Continuous positive airway pressure;    High flow nasal cannula;   

Others  :  1232668
DOI  :  10.1186/s12887-015-0462-0

 received in 2015-08-04, accepted in 2015-09-22,  发布年份 2015

【 摘 要 】

Background

The optimal strategy for weaning very preterm infants from nasal continuous positive airway pressure (NCPAP) is unclear. Reported strategies include weaning NCPAP to a predefined pressure then trialling stopping completely (abrupt wean); alternate periods of increased time off NCPAP whilst reducing time on until the infant is completely weaned (gradual wean); and using high flow nasal cannula (HFNC) to assist the weaning process. The aim of this study was to determine the optimal weaning from NCPAP strategy for very preterm infants.

Methods

A pilot single centre, factorial design, 4-arm randomised controlled trial. Sixty infants born <30 weeks gestation meeting stability criteria on NCPAP were randomly allocated to one of four groups. Group 1: abrupt wean with HFNC; Group 2: abrupt wean without HFNC; Group 3: gradual wean with HFNC; Group 4: gradual wean without HFNC. The primary outcomes were duration of respiratory support, chronic lung disease, length of hospital stay and time to full suck feeds.

Results

The primary outcome measures were not significantly different between groups. Group 1 had a significant reduction in duration of NCPAP (group 1: median 1 day; group 2: 24 days; group 3: 15 days; group 4: 24 days; p = 0.002) and earlier corrected gestational age off NCPAP. There was a significant difference in rate of parental withdrawal from the study, with group 2 having the highest rate. Group 3 had a significantly increased duration on HFNC compared to group 1.

Conclusions

Use of high flow nasal cannula may be effective at weaning infants from NCPAP but did not reduce duration of respiratory support or time to full suck feeds. Abrupt wean without the use of HFNC was associated with an increased rate of withdrawal by parent request.

Trial registration

This study is registered at the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au/). (Registration Number = ACTRN12610001003066).

【 授权许可】

   
2015 Tang et al.

【 图 表 】

Fig. 1.

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