Skip to main content
NCBI home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2001 Sep;85(2):F82–F85. doi: 10.1136/fn.85.2.F82

A randomised controlled trial of two methods of delivering nasal continuous positive airway pressure after extubation to infants weighing less than 1000 g: binasal (Hudson) versus single nasal prongs

P Davis, M Davies, B Faber
PMCID: PMC1721310  PMID: 11517198

Abstract

OBJECTIVES—Primary: to determine whether nasal continuous positive airway pressure (CPAP) delivered through binasal prongs results in a greater proportion of extremely low birthweight infants being successfully extubated, after a period of intermittent positive pressure ventilation, than nasal CPAP delivered by a single nasal prong. Secondary: to evaluate the effect of mode of delivery of nasal CPAP after extubation on the need for endotracheal reintubation, weight gain, rates of feeding intolerance, sepsis, suspected sepsis, cranial ultrasound abnormalities, retinopathy of prematurity, chronic lung disease, and the duration of assisted ventilation and care in the tertiary neonatal unit.
DESIGN AND SETTING—Randomised, controlled, clinical trial conducted at the neonatal intensive care unit of the Royal Women's Hospital, Melbourne, Australia.
PATIENTS—Infants of birth weight less than 1000 g, ventilated, requiring < 50% oxygen and ventilator rate less than or equal to 20/minute, and considered by the clinical management team to be ready for extubation.
INTERVENTION—Infants were randomly allocated to receive nasal CPAP delivered through binasal (Hudson) prongs or a single nasal prong.
PRIMARY OUTCOME MEASURE—Failure of extubation as defined by the following criteria: (a) apnoea (more than one episode/hour over a six hour period or one episode requiring bag and mask ventilation); (b) absolute increase in oxygen requirement greater than 15% above that required before extubation; (c) respiratory acidosis (pH < 7.25 with PCO2 > 6.67 kPa).
RESULTS—Ten of the 41 (24%) infants randomised to binasal prongs reached predetermined failure criteria compared with 26 of the 46(57%) infants randomised to a single nasal prong (p = 0.005). Four of 17 (24%) infants of birth weight less than 800 g extubated to binasal prongs reached failure criteria compared with 14 of 16 (88%) extubated to a single nasal prong (p < 0.001). There were no significant differences in any of the secondary outcomes.
CONCLUSIONS—For extremely low birthweight infants ventilated using an endotracheal tube, nasal CPAP delivered through binasal (Hudson) prongs is more effective in preventing failure of extubation than that delivered through a single nasal prong.



Full Text

The Full Text of this article is available as a PDF (137.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahluwalia J. S., White D. K., Morley C. J. Infant Flow Driver or single prong nasal continuous positive airway pressure: short-term physiological effects. Acta Paediatr. 1998 Mar;87(3):325–327. doi: 10.1080/08035259850157408. [DOI] [PubMed] [Google Scholar]
  2. Allen L. P., Reynolds E. R., Rivers R. P., Le Souëf P. M., Wimberley P. D. Controlled trial of continuous positive airway pressure given by face mask for hyaline membrane disease. Arch Dis Child. 1977 May;52(5):373–378. doi: 10.1136/adc.52.5.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Avery M. E., Tooley W. H., Keller J. B., Hurd S. S., Bryan M. H., Cotton R. B., Epstein M. F., Fitzhardinge P. M., Hansen C. B., Hansen T. N. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics. 1987 Jan;79(1):26–30. [PubMed] [Google Scholar]
  4. Davis P., Jankov R., Doyle L., Henschke P. Randomised, controlled trial of nasal continuous positive airway pressure in the extubation of infants weighing 600 to 1250 g. Arch Dis Child Fetal Neonatal Ed. 1998 Jul;79(1):F54–F57. doi: 10.1136/fn.79.1.f54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gregory G. A., Kitterman J. A., Phibbs R. H., Tooley W. H., Hamilton W. K. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 1971 Jun 17;284(24):1333–1340. doi: 10.1056/NEJM197106172842401. [DOI] [PubMed] [Google Scholar]
  6. Kavvadia V., Greenough A., Dimitriou G. Effect on lung function of continuous positive airway pressure administered either by infant flow driver or a single nasal prong. Eur J Pediatr. 2000 Apr;159(4):289–292. doi: 10.1007/s004310050072. [DOI] [PubMed] [Google Scholar]
  7. Morley C. Continuous distending pressure. Arch Dis Child Fetal Neonatal Ed. 1999 Sep;81(2):F152–F156. doi: 10.1136/fn.81.2.f152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. O'Brien P. C., Fleming T. R. A multiple testing procedure for clinical trials. Biometrics. 1979 Sep;35(3):549–556. [PubMed] [Google Scholar]
  9. Papile L. A., Burstein J., Burstein R., Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978 Apr;92(4):529–534. doi: 10.1016/s0022-3476(78)80282-0. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES