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Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants

Overview of attention for article published in Cochrane database of systematic reviews, April 2003
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Title
Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants
Published in
Cochrane database of systematic reviews, April 2003
DOI 10.1002/14651858.cd000143
Pubmed ID
Authors

Peter G Davis, David J Henderson-Smart

Abstract

Preterm infants being extubated following a period of intermittent positive pressure ventilation via an endotracheal tube are at risk of developing respiratory failure as a result of apnea, respiratory acidosis and hypoxia. Nasal continuous positive airway pressure appears to stabilise the upper airway, improve lung function and reduce apnea and may therefore have a role in facilitating extubation in this population. In preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), does management with nasal continuous positive airways pressure (NCPAP) lead to an increased proportion remaining free of additional ventilatory support, compared to extubation directly to headbox oxygen? Searches were made of the Oxford Database of Perinatal Trials, MEDLINE up to November 2002, Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2002), previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants and journal handsearching mainly in the English language. All trials utilising random or quasi-random patient allocation, in which NCPAP (delivered by any method) was compared with headbox oxygen for post-extubation care were included. Methodological quality was assessed independently by the two authors. Data were extracted independently by the two authors. Prespecified subgroup analysis to determine the impact of different levels of NCPAP, differences in duration of IPPV and use of aminophylline were also performed using the same package. Data were analysed using relative risk (RR), risk difference (RD) and number needed to treat (NNT). Nasal CPAP, when applied to preterm infants being extubated following IPPV, reduces the incidence of adverse clinical events (apnea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support [RR 0.62 (0.49, 0.77), RD -0.17 (-0.24,-0.10), NNT 6 (4,10)]. nasal CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV. Implication for research: further definition of the gestational age and weight groups in whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.

Mendeley readers

The data shown below were compiled from readership statistics for 73 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Switzerland 1 1%
United States 1 1%
Netherlands 1 1%
Canada 1 1%
Unknown 69 95%

Demographic breakdown

Readers by professional status Count As %
Other 10 14%
Unspecified 9 12%
Student > Postgraduate 9 12%
Researcher 8 11%
Student > Master 7 10%
Other 30 41%
Readers by discipline Count As %
Medicine and Dentistry 54 74%
Unspecified 11 15%
Linguistics 1 1%
Biochemistry, Genetics and Molecular Biology 1 1%
Pharmacology, Toxicology and Pharmaceutical Science 1 1%
Other 5 7%