Intervention Review

Extubation from low-rate intermittent positive airway pressure versus extubation after a trial of endotracheal continuous positive airway pressure in intubated preterm infants

  1. Peter G Davis1,*,
  2. David J Henderson-Smart2

Editorial Group: Cochrane Neonatal Group

Published Online: 23 OCT 2001

Assessed as up-to-date: 6 DEC 2007

DOI: 10.1002/14651858.CD001078


How to Cite

Davis PG, Henderson-Smart DJ. Extubation from low-rate intermittent positive airway pressure versus extubation after a trial of endotracheal continuous positive airway pressure in intubated preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001078. DOI: 10.1002/14651858.CD001078.

Author Information

  1. 1

    Royal Women's Hospital, Department of Paediatrics, Parkville, Victoria, Australia

  2. 2

    Queen Elizabeth II Research Institute, NSW Centre for Perinatal Health Services Research, Sydney, NSW, Australia

*Peter G Davis, Department of Paediatrics, Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria, 3052, Australia. pgd@unimelb.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 OCT 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Failure of extubation and subsequent reintubation may result in additional stress and trauma to the premature infant. Treating infants about to be extubated with a period of endotracheal CPAP has been suggested as a method of preparing for extubation. However, this process has been criticized as increasing the neonate's work of breathing and perhaps increasing the likelihood of extubation failure.

Objectives

In premature infants having their endotracheal tube removed, is direct extubation from low rate intermittent positive pressure ventilation (IPPV) more successful than that following a period of endotracheal continuous positive airway pressure (CPAP)?

Search methods

The standard search strategy of the Cochrane Neonatal Review Group as outlined in The Cochrane Library was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants and journal hand searching mainly in the English language. These searches were updated in November 2007.

Selection criteria

Trials were included that used random or quasi-random allocation and compared extubation of premature infants following a period of endotracheal CPAP to direct extubation following IPPV.

Data collection and analysis

Data were extracted using standard methods of the Cochrane Collaboration and its Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk.

Main results

Three trials were identified that compared extubation of premature infants following a period of endotracheal CPAP to direct extubation following IPPV. Direct extubation from low rate ventilation is associated with a trend towards an increased chance of successful extubation when compared to extubation after a period of endotracheal CPAP, [typical RR 0.45 (0.19, 1.07), typical RD -0.103 (-0.200, -0.006), NNT 10 (5, 167)]. When only truly randomized trials are considered, this result becomes both statistically significant and clinically important, [typical RR 0.10 (0.01, 0.78), typical RD -0.201 (-0.319, -0.083), NNT 5 (3, 12)]. Similar differences are seen for the secondary outcome, apnea.

Authors' conclusions

Preterm infants no longer requiring endotracheal intubation and IPPV should be directly extubated without a trial of ETT CPAP.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Extubation from low-rate intermittent positive airway pressure versus extubation after a trial of endotracheal continuous positive airway pressure in intubated preterm infants

There is no evidence that time on endotracheal CPAP (continuous low pressure rather than intermittent breaths from the ventilator) before taking preterm babies off a ventilator helps them adjust to breathing on their own. Babies in neonatal intensive care often need help to breathe, sometimes via an endotracheal tube (through the windpipe) connected to a mechanical ventilator. It was thought that it might help a baby adjust to breathing after ventilation if there was a period of CPAP (continuous positive airways pressure) before extubation (coming off the ventilator). However, there have also been concerns that this may create too much work for the baby, and may cause harm. This review found that a trial of CPAP before extubation does not improve the baby's ability to breathe on their own.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

插管早產兒的低頻間歇性正壓與氣管內持續性氣道正壓呼吸(CPAP)後拔管的比較

拔管失敗而重插管可能造成早產兒額外刺激和創傷。在拔管前先給嬰兒施與一段時間氣管內持續氣道正壓呼吸(CPAP)曾被建議作為拔管的準備處置。然而,該措施曾被質疑增加新生兒呼吸的負荷反增加拔管失敗的可能性。

目標

在早產兒直接拔管用低頻間歇正壓呼吸(IPPV)是否比預先時間氣管內持續氣道正壓呼吸(CPAP)後再拔管更容易成功地拔除氣管插管?

搜尋策略

使用 Cochrane Neonatal Review Group規範的標準檢索策略, 包括檢索Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE,含以往回顧的參考文獻、摘要、會議和研討會論文集、專家訊信,及手工檢索主要是英語的雜誌。於 2003年3月進行更新檢索。

選擇標準

納入所有以隨機或半隨機法分配與比較早產兒進行氣管內CPAP後拔管或直接拔管再接受IPPV的試驗。 。

資料收集與分析

以CCochrane Collaboration及其 Neonatal Review Group的標準方法進行資料提取,每位作者分別進行試驗質量評估和數據提取,用相對風險(RR)進行數據綜合分析。

主要結論

三項試驗比較早產兒先接受CPAP再拔管與先拔管再IPPV。IPPV組有較高拔管成功機會的傾向[RR 0.45 (0.19,1.07), RD −0.103 (−0.200,−0.006), NNT 10 (5,167)]。當只考慮隨機試驗時,該結果不僅有統計學意義而且有臨床重要性,RR 0.10 (0.01,0.78),RD −0.201 (−0.319,−0.083),NNT 5 (3,12)。次要結果,窒息,也有類似差異。

作者結論

早產兒在不再需要氣管插管時應直接拔管用IPPV而不用再先試CPAP。

翻譯人

本摘要由臺中榮民總醫院葉惠英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

插管早產兒的低頻間歇性正壓與氣管內持續性氣道正壓呼吸(CPAP)後拔管的比較: 沒有證據支持氣管內持續性氣道正壓呼吸(CPAP)有助於早產兒自行調整脫離呼吸器。在新生兒加護中心的嬰兒經查需要經由氣管內插管藉由呼吸器呼吸。認為拔管前用CPAP可能可以幫使用呼吸器的嬰兒調整呼吸用。然而也擔心造成嬰兒太多負荷可能造成傷害。本回顧發現拔管前使用CPAP無法改善應而自行呼吸的能力。