CPAP Versus NIPPV Postextubation in Preterm Neonates: A Comparative-Effectiveness Study.

Autor:	Mukerji A; McMaster Children's Hospital, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada., Read B; London Health Sciences Centre, London, Ontario, Canada., Yang J; Mount Sinai Hospital, Department of Pediatrics., Baczynski M; Mount Sinai Hospital, Department of Pediatrics., Ng E; Sunnybrook Health Sciences Centre, Department of Pediatrics., Dunn M; Sunnybrook Health Sciences Centre, Department of Pediatrics., Ethier G; CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada., Abou Mehrem A; Foothills Medical Centre, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada., Beltempo M; Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada., Drolet C; CHU de Quebec, Department of Pediatrics, Laval University, Quebec, Quebec City, Canada., da Silva O; London Health Sciences Centre, Department of Pediatrics, Western University, London, Ontario, Canada., Louis D; Health Sciences Centre and St. Boniface Hospital, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada., Lemyre B; The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada., Afifi J; IWK Health Centre., Singh B; IWK Health Centre., Sherlock R; Surrey Memorial Hospital, Surrey., Stavel M; Royal Columbia Hospital, New Westminster., Masse E; CIUSSSE-CHUS, Department of Pediatrics, University of Sherbrooke, Quebec, Canada., Kanungo J; Royal Victoria Hospital, University of Victoria, Victoria, British Columbia, Canada., Wong J; BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Bodani J; Regina General Hospital, Department of Pediatrics, University of Regina, Regina, Saskatchewan, Canada., Khurshid F; Kingston General Hospital, Queen's University, Kingston, Ontario, Canada., Lee KS; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Augustine S; Windsor Regional Hospital, Windsor., de Oliveira CB; The Moncton Hospital, Moncton., Makary H; Dr Everett Chalmers Hospital, Fredericton., Newman A; Saint John Regional Hospital, Saint John, New Brunswick, Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada., Ojah C; Saint John Regional Hospital, Saint John, New Brunswick, Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada., Shah PS; Mount Sinai Hospital, Department of Pediatrics.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2024 Apr 01; Vol. 153 (4).
DOI:	10.1542/peds.2023-064045
Abstrakt:	Background and Objectives: Nasal intermittent positive pressure ventilation (NIPPV) has been shown to be superior to nasal continuous positive airway pressure (CPAP) postextubation in preterm neonates. However, studies have not permitted high CPAP pressures or rescue with other modes. We hypothesized that if CPAP pressures >8 cmH2O and rescue with other modes were permitted, CPAP would be noninferior to NIPPV. Methods: We conducted a pragmatic, comparative-effectiveness, noninferiority study utilizing network-based real-world data from 22 Canadian NICUs. Centers self-selected CPAP or NIPPV as their standard postextubation mode for preterm neonates <29 weeks' gestation. The primary outcome was failure of the initial mode ≤72 hours. Secondary outcomes included failure ≤7 days, and reintubation ≤72 hours and ≤7 days. Groups were compared using a noninferiority adjusted risk-difference (aRD) margin of 0.05, and margin of no difference. Results: A total of 843 infants extubated to CPAP and 974 extubated to NIPPV were included. CPAP was not noninferior (and inferior) to NIPPV for failure of the initial mode ≤72 hours (33.0% vs 26.3%; aRD 0.07 [0.03 to 0.12], Pnoninferiority(NI) = .86), and ≤7 days (40.7% vs 35.8%; aRD 0.09 [0.05 to 0.13], PNI = 0.97). However, CPAP was noninferior (and equivalent) to NIPPV for reintubation ≤72 hours (13.2% vs 16.1%; aRD 0.01 [-0.05 to 0.02], PNI < .01), and noninferior (and superior) for reintubation ≤7 days (16.4% vs 22.8%; aRD -0.04 [-0.07 to -0.001], PNI < .01). Conclusions: CPAP was not noninferior to NIPPV for failure ≤72 hours postextubation; however, it was noninferior to NIPPV for reintubation ≤72 hours and ≤7 days. This suggests CPAP may be a reasonable initial postextubation mode if alternate rescue strategies are available. (Copyright © 2024 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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