Postextubation nasal continuous positive airway pressure. A prospective controlled study
S. C. Engelke, D. W. Roloff and L. R. Kuhns
Nasal continuous positive airway pressure (N-CPAP), applied immediately
after extubation, was prospectively evaluated in 18 neonates recovering
from respiratory distress syndrome. Patients were randomly assigned to
N-CPAP (group 1, N=9) or a control group given oxygen by hood (group 2,
N=9). Groups were comparable in birth weight and duration of intubation. In
the 24-hour period following extubation, group 1 showed a significantly
lower mean respiratory rate (46 +/- 2 vs 74 +/- 4), alveolar-arterial
oxygen gradient (94 +/- 9 vs 134 +/- 12 mm Hg), PCO2 (45 +/- 1 vs 50 +/- 1
mm Hg), higher pH (7.33 +/- 0.01 vs 7.30 +/- 0.01), and less atelectasis by
roentgenographic scores. This was associated with considerably better
clinical courses in group 1 when compared with group 2, in which six
patients required a late trial of N-CPAP because of respiratory
deterioration and two patients needed reintubation. Postextubation N-CPAP
has a striking beneficial effect on respiratory function and prevention of
atelectasis.
