Does continuous positive airway pressure (CPAP) during weaning from intermittent mandatory ventilation in very low birth weight infants have risks or benefits? A controlled trial

Objective: The purpose of this study was to evaluate three ventilator weaning strategies and to evaluate whether the use of continuous positive airway pressure (CPAP) via a nasopharyngeal or endotracheal tube would increase the likelihood of extubation failure in very low birth weight (VLBW) infants. Study design: We studied prospectively 87 preterm infants (mean ± SD; birth weight: 1078 ± 188 g; gestational age: 28.8 ± 2.2 weeks) who were in the process of being weaned from intermittent mandatory ventilation (IMV). Infants were assigned by systematic sampling to one of the following three treatment groups: (1) direct extubation from IMV (D.EXT) ( n = 30); (2) preextubation endotracheal CPAP (ET‐CPAP) for 12–24 hr ( n = 28); or (3) postextubation nasopharyngeal CPAP (NP‐CPAP) for 12–24 hr ( n = 29). Failure was defined as the need for resumption of mechanical ventilation within 72 hr of extubation due to frequent or severe apnea and/or respiratory failure (pH < 7.25, PaCO 2 > 60 mm Hg, and/or requirement for oxygen FiO 2 > 60%). Results: There were no significant differences in failure rates among the three procedures. Failures were 2/30 (7%) in D.EXT; 4/28 (14%) in ET‐CPAP; and 7/29 (24%) in the NP‐CPAP. There were also no differences in FiO 2 , PaO 2 , and respiratory rates before and after discontinuation of IMV among the three groups. PaCO 2 values were slightly higher in the NP‐CPAP group 12–24 hr after weaning from IMV. Conclusion: We were unable to demonstrate a clear difference in extubation outcome by use of CPAP administered via an endotracheal or nasopharyngeal tube when compared to direct extubation from low‐rate IMV in VLBW infants. © 1995 Wiley‐Liss, Inc.