Comparison of post-extubation bubble CPAP / HFNC / Oxygen hood in neonates requiring invasive mechanical ventilation .

Abstract

Background: There are different forms of respiratory support which can be provided to a neonate including: Non-invasive respiration support (NRS) provided without use of ETT, consisting of Oxygen supplementation without M. V. , Continuous positive airway pressure (CPAP) , Non-invasive positive pressure ventilation (NIPPV) ; Mechanical ventilation i. e. , invasive respiratory support provided via artificial airway (endotracheal tube or trachesotomy tube) ; each having its own advantages and dis-advantages. The gradual process by which mechanical ventilation is discontinued and the patient resumes spontaneous breathing is called weaning. Non invasive respiratory support (NRS) can be used for post extubation management in neonates to prevent extubation failure. NRS that can be used includes CPAP, NIPPV, HFNC. Besides these patients can be extubated to oxygen hood.

OBJECTIVES: Comparison of post-extubation bubble CPAP, HFNC & oxygen hood in neonates requiring invasive ventilation with respect to: Failure rate in terms of requirement of reintubation within 72 hours of extubation.

Design of study: observational study

METHODS: The study was conducted in department of paediatrics and neonatology, SKIMS, Soura from august 2017 to July 2019.

METHODOLGY: All neonates requiring endotracheal intubation and invasive mechanical ventilation for respiratory or non respiratory indications (ventilated on pressure control mode) , once already extubated by the clinical team and put on bubble cpap or hfnc or under oxygen hood based on availability of the said extubation means; were observed for failure in terms of requirement of reintubation within 72 hours of extubation. Similar number of cases was observed in each cohort, each cohort was further stratified, similar number of cases was observed in each stratum to overcome known confounding factors. Stratification was done as follows: gestational age: <=34wks (excluding those less than 28 weeks gestation) , >34wks

After two years of observation period comparison was done so as to conclude better means of extubation with respect to each cohort.

RESULT: A total of 103 infants were observed from august 2017 to July 2019, 34 in oxygen hood, 35 in high flow nasal cannula and 34 in bubble C-PAP cohort. Each cohort was further stratified according to gestational age, duration of MV and indication of MV. Extubation failure rates in each cohort and its strata were compared to determine the relative efficacy of the three extubation means. Overall extubation failure rate was 17.6% in bubble C-PAP cohort, 20 % in HFNC cohort and 44.1 % in oxygen hood cohort… (Results abriged)

CONCLUSION: In summary oxygen-hood produced higher overall extubation failure rates than nasal continuous positive airway pressure and high flow nasal cannula. In pre-terms also oxygen-hood as postextubation means has higher failure rate than CPAP and HFNC. But no significant difference is seen between HFNC and CPAP, which means none is inferior to other. Oxygen-hood was found to have higher failure in preterms less than 34wks gestation than in term neonates more than 34wks gestation.