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Efficacy of noninvasive respiratory support modes as postextubation respiratory support in preterm neonates: A systematic review and network meta‐analysis
Author(s) -
Ramaswamy Viraraghavan Vadakkencherry,
Bandyopadhyay Tapas,
Nanda Debasish,
Bandiya Prathik,
More Kiran,
Oommen Vinod Idicula,
Gupta Amit
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25007
Subject(s) - medicine , continuous positive airway pressure , nasal cannula , anesthesia , cannula , surgery , obstructive sleep apnea
Background Multiple noninvasive respiratory support (NRS) modalities are used for postextubation support in preterm neonates. Seven NRS modalities were compared—constant flow continuous positive airway pressure (CPAP) (CF‐CPAP) (bubble CPAP; ventilator CPAP), variable flow CPAP (VF‐CPAP), high flow nasal cannula (HFNC), synchronized noninvasive positive pressure ventilation (S‐NIPPV), nonsynchronized NIPPV (NS‐NIPPV), bilevel CPAP (BiPAP), noninvasive high‐frequency oscillation ventilation (nHFOV). Design Systematic review and network meta‐analysis (NMA) using the Bayesian random‐effects approach. MEDLINE, EMBASE, CENTRAL, WHO‐ICTRP were searched. Main Outcome Measure Requirement of invasive mechanical ventilation within 7 days of extubation. Results A total of 33 studies with 4080 preterm neonates were included. S‐NIPPV, NS‐NIPPV, nHFOV, and VF‐CPAP were more efficacious in preventing reintubation than CF‐CPAP (risk ratio [RR] [95% credible intervals {CrI}]: 0.22 [0.12, 0.35]; 0.44 [0.27, 0.67]; 0.42 [0.18, 0.81]; 0.73 [0.52, 0.99]). Surface under the cumulative ranking curve (SUCRA) value ranked S‐NIPPV to be the best postextubation intervention (SUCRA: 0.98). S‐NIPPV was more effective than NS‐NIPPV, BiPAP, VF‐CPAP, and HFNC (RR [95% CrI]: 0.52 [0.24, 0.97]; 0.32 [0.14, 0.64]; 0.30 [0.16, 0.50]; 0.24 [0.12, 0.41]). NS‐NIPPV resulted in lesser reintubation compared to VF‐CPAP and HFNC (RR [95% CrI]: 0.61 [0.36, 0.97]; 0.49 [0.27, 0.80]). BiPAP, VF‐CPAP, and HFNC had comparable efficacies. The overall quality of evidence was very low to moderate. Conclusion Results of this NMA indicate that S‐NIPPV might be the most effective and CF‐CPAP the least effective NRS modality for preventing extubation failure.