Randomized trial of continuous positive airways pressure to prevent reventilation in preterm infants

A prospective randomized controlled trial was performed comparing the use of a short period (24 hr) of postextubation nasal continuous positive airways pressure (CPAP) with direct extubation into headbox oxygen on the outcome of the need for reintubation within 7 days of initial extubation. Infants at less than 32 weeks of gestation who had received mechanical ventilation in the first 28 postnatal days and were being extubated for the first time were recruited. Ninety-seven babies were entered into the study (48 CPAP and 49 headbox oxygen). Twenty-four (49%) babies in the headbox group were reventilated within a week, compared to 16 (33%) in the CPAP group (P = 0.17). By 14 days after initial extubation, 25 babies (51%) in the headbox group and 23 (48%) in the CPAP group required reventilation (P = 0.9). There was a trend toward babies in the CPAP group requiring fewer reintubations (median, 2; range, 1–6) compared to those in the headbox group (median, 3; range, 1–7) (P = 0.063). There was no significant difference between groups with respect to total number of days of ventilation (headbox median, 4; range, 1–24; CPAP median, 2; range, 1–20). In conclusion, this study showed that a short period of nasal CPAP is not associated with a reduction in reventilation.