Application of nasal bi level positive airway pressure and continuous positive airway pressure in premature neonates with severe neonatal respiratory distress syndrome after extubation

doi:10.3877/cma.j.issn.1673-5250.2020.03.009

Objective

To investigate the clinical curative effect of nasal bi level positive airway pressure (BIPAP) and continuous positive airway pressure (CPAP) after extubation of premature neonates with severe neonatal respiratory distress syndrome (NRDS).

Methods

From January 2014 to January 2016, a total of 75 cases of severe NRDS premature neonates (hereinafter referred to as subjects) who were hospitalized in Qilu Children′s Hospital of Shandong University, were selected as research subjects. They were divided into BIPAP group (n=37) and CPAP group (n=38) by random digits table method. After extubation of invasive mechanical ventilation (MV), they took measures of nasal BIPAP/CPAP for noninvasive MV treatment. The general clinical data on admission, therapeutic effects of nasal BIPAP/CPAP treatment between two groups were compared statistically by independent-samples t test and chi square test. This study was approved by the Medical Ethics Committee of case collection hospital (Approval No: ETYY-2020202). The guardians of the subjects all gave informed consents and signed the informed consents.

Results

Results were as follows. ① Comparison of general clinical data: there were no significant differences between two groups of subjects in age on admission, gestational age, birth weight, Apgar scores of 1 min and 5 min after birth, the proportions of NRDS Ⅲ/Ⅳ and subjects delivered by cesarean section, and the subjects proportions of mothers with turbid amniotic fluid, premature rupture of membranes and the history of prenatal use of hormones (P>0.05). ② Comparison of efficacy variable of BIPAP/CPAP: the failure rate of extubation, duration of BIPAP treatment and the arterial partial pressure of carbon dioxide (PaCO₂) 2 days after extubation of subjects in BIPAP group were 13.5%, (5.0±0.6) d and (39.5±3.5) mmHg (1 mmHg=0.133 kPa), which were significantly lower or less than those of 34.2%, (6.4±1.0) d and (54.8±4.3) mmHg in CPAP group, and the differences were statistically significant (χ²=4.402, P=0.035; t=2.970, P=0.019; t=16.873, P<0.001). Arterial partial pressure of oxygen (PaO₂) immediately and 2 days after extubation of subjects in BIPAP group were (65.4±5.8) mmHg and (83.0±6.9) mmHg, which were significantly higher than those of (54.4±8.1) mmHg and (80.2±4.0) mmHg in CPAP group, and the differences were statistically significant (t=6.715, P<0.001; t=2.157, P=0.017). ③ Comparison of short-term prognostic indicators: the incidence of apnea/bradycardia of subjects in BIPAP group was 16.2%, which was significantly lower than that of 39.5% in CPAP group, and the difference was statistically significant (χ²=5.029, P=0.024). There were no significant differences between two groups of subjects in hospitalization time, incidence of abdominal distension/nasal septal injury, bronchopulmonary dysplasia (BPD), neonatal necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP) and intraventricular hemorrhage (IVH), as well as mortality (P>0.05).

Conclusion

Application of BIPAP after extubation, can help premature neonates with severe NRDS successful extubation, and it is an effective lung protection strategy.

Key words: Respiratory distress syndrome, newborn, Ventilator weaning, Successful extubation, Continuous positive airway pressure, Bilevel positive airway pressure, Infant, premature

表1 2组受试儿入院时一般临床资料比较

组别	例数	年龄(h，±s)	胎龄(周，±s)	出生体重(g，±s)	Apgar评分(分，±s)
组别	例数	年龄(h，±s)	胎龄(周，±s)	出生体重(g，±s)	生后1 min	生后5 min
BIPAP组	37	2.0±0.7	30.0±1.3	1 981±87	5.4±1.5	7.3±0.8
CPAP组	38	2.1±0.5	30.0±1.4	1 952±83	5.6±1.0	6.9±0.8
检验值		t＝0.713	t＝0.160	t＝1.477	t＝0.681	t＝1.677
P值		0.478	0.873	0.143	0.498	0.097
组别	例数	NRDS Ⅲ/Ⅳ级[例数(%)]	经剖宫产术娩出[例数(%)]	母亲情况[例数(%)]
组别	例数	NRDS Ⅲ/Ⅳ级[例数(%)]	经剖宫产术娩出[例数(%)]	羊水浑浊	胎膜早破	产前使用激素
BIPAP组	37	21(56.7)	11(29.7)	4(10.8)	25(67.0)	25(67.5)
CPAP组	38	22(57.8)	12(31.5)	6(15.7)	28(73.6)	25(65.7)
检验值		χ²＝0.009	χ²＝0.030	χ²＝0.402	χ²＝0.338	χ²＝0.026
P值		0.920	0.862	0.525	0.560	0.870

表1 2组受试儿入院时一般临床资料比较

组别	例数	年龄(h，±s)	胎龄(周，±s)	出生体重(g，±s)	Apgar评分(分，±s)
组别	例数	年龄(h，±s)	胎龄(周，±s)	出生体重(g，±s)	生后1 min	生后5 min
BIPAP组	37	2.0±0.7	30.0±1.3	1 981±87	5.4±1.5	7.3±0.8
CPAP组	38	2.1±0.5	30.0±1.4	1 952±83	5.6±1.0	6.9±0.8
检验值		t＝0.713	t＝0.160	t＝1.477	t＝0.681	t＝1.677
P值		0.478	0.873	0.143	0.498	0.097
组别	例数	NRDS Ⅲ/Ⅳ级[例数(%)]	经剖宫产术娩出[例数(%)]	母亲情况[例数(%)]
组别	例数	NRDS Ⅲ/Ⅳ级[例数(%)]	经剖宫产术娩出[例数(%)]	羊水浑浊	胎膜早破	产前使用激素
BIPAP组	37	21(56.7)	11(29.7)	4(10.8)	25(67.0)	25(67.5)
CPAP组	38	22(57.8)	12(31.5)	6(15.7)	28(73.6)	25(65.7)
检验值		χ²＝0.009	χ²＝0.030	χ²＝0.402	χ²＝0.338	χ²＝0.026
P值		0.920	0.862	0.525	0.560	0.870

表2 2组受试儿有创MV撤机后，BIPAP/CPAP治疗的疗效比较

组别	例数	撤机失败[例数(%)]	治疗时间(d，±s)	动脉血pH值(±s)		PaO₂(mmHg，±s)		PaCO₂(mmHg，±s)
组别	例数	撤机失败[例数(%)]	治疗时间(d，±s)	撤机即刻	撤机后2 d	撤机即刻	撤机后2 d	撤机即刻	撤机后2 d
BIPAP组	37	5(13.5)	5.0±0.6	7.4±4.6	7.5±3.0	65.4±5.8	83.0±6.9	48.2±3.1	39.5±3.5
CPAP组	38	13(34.2)	6.4±1.0	7.4±4.5	7.5±2.9	54.4±8.1	80.2±4.0	48.0±1.5	54.8±4.3
检验值		χ²＝4.402	t＝2.970	t＝0.000	t＝0.000	t＝6.715	t＝2.157	t＝0.357	t＝16.873
P值		0.035	0.019	1.000	1.000	<0.001	0.017	0.722	<0.001

表2 2组受试儿有创MV撤机后，BIPAP/CPAP治疗的疗效比较

组别	例数	撤机失败[例数(%)]	治疗时间(d，±s)	动脉血pH值(±s)		PaO₂(mmHg，±s)		PaCO₂(mmHg，±s)
组别	例数	撤机失败[例数(%)]	治疗时间(d，±s)	撤机即刻	撤机后2 d	撤机即刻	撤机后2 d	撤机即刻	撤机后2 d
BIPAP组	37	5(13.5)	5.0±0.6	7.4±4.6	7.5±3.0	65.4±5.8	83.0±6.9	48.2±3.1	39.5±3.5
CPAP组	38	13(34.2)	6.4±1.0	7.4±4.5	7.5±2.9	54.4±8.1	80.2±4.0	48.0±1.5	54.8±4.3
检验值		χ²＝4.402	t＝2.970	t＝0.000	t＝0.000	t＝6.715	t＝2.157	t＝0.357	t＝16.873
P值		0.035	0.019	1.000	1.000	<0.001	0.017	0.722	<0.001

表3 2组受试儿短期预后比较

组别	例数	住院时间(d，±s)	腹胀/鼻中隔损伤[例数(%)]	呼吸暂停/心动过缓[例数(%)]	BPD[例数(%)]	NEC[例数(%)]	ROP[例数(%)]	IVH[例数(%)]	死亡[例数(%)]
BIPAP组	37	31.7±5.0	5(13.5)	6(16.2)	6(16.2)	3(8.1)	3(8.1)	4(10.8)	3(8.1)
CPAP组	38	34.1±5.4	6(15.8)	15(39.5)	6(15.8)	5(13.2)	4(10.5)	3(7.9)	4(10.5)
检验值		t＝1.990	χ²＝0.077	χ²＝5.029	χ²＝0.002	χ²＝0.501	χ²＝0.129	χ²＝0.188	χ²＝0.129
P值		0.050	0.780	0.024	0.959	0.478	0.718	0.664	0.718

表3 2组受试儿短期预后比较

组别	例数	住院时间(d，±s)	腹胀/鼻中隔损伤[例数(%)]	呼吸暂停/心动过缓[例数(%)]	BPD[例数(%)]	NEC[例数(%)]	ROP[例数(%)]	IVH[例数(%)]	死亡[例数(%)]
BIPAP组	37	31.7±5.0	5(13.5)	6(16.2)	6(16.2)	3(8.1)	3(8.1)	4(10.8)	3(8.1)
CPAP组	38	34.1±5.4	6(15.8)	15(39.5)	6(15.8)	5(13.2)	4(10.5)	3(7.9)	4(10.5)
检验值		t＝1.990	χ²＝0.077	χ²＝5.029	χ²＝0.002	χ²＝0.501	χ²＝0.129	χ²＝0.188	χ²＝0.129
P值		0.050	0.780	0.024	0.959	0.478	0.718	0.664	0.718

[1]	Sankaran K, Adegbite M. Noninvasive respiratory support in neonates: a brief review[J]. Chin J Contemp Pediatr, 2012, 14(9): 643-652.
[2]	唐玉英，李涛，付生军，等. 双水平正压通气和经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征的疗效和并发症Meta分析[J]. 中国循证儿科杂志，2014, 9(4): 288-293. DOI: 10.3969/j.issn.1673-5501.2014.04.010.
[3]	邵肖梅，叶鸿瑁，丘小汕. 实用新生儿学[M]. 4版. 北京：人民卫生出版社，2011: 396.
[4]	周晓光，肖昕，农绍汉. 新生儿机械通气治疗学[M]. 北京：人民卫生出版社，2004: 178-189.
[5]	Ancora G, Maranella E, Grandi S, et al. Role of bilevel positive airway pressure in the management of preterm newborns who have received surfactant[J]. Acta Paediatr, 2010, 99(12): 1807-1811. DOI: 10.1111/j.1651-2227.2010.01910.x.
[6]	Victor S, Extubate Trial Group. Extubate: a randomised controlled trial of nasal biphasic positive airway pressure vs. nasal continuous positive airway pressure following extubation in infants less than 30 weeks′ gestation: study protocol for a randomised controlled trial[J]. Trials, 2011, 12: 257. DOI: 10.1186/1745-6215-12-257.
[7]	Lampland AL, Plumm B, Worwa C, et al. Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(9): 883. DOI: 10.1136/fetalneonatal-2013-305665.
[8]	Lista G, Castoldi F, Fontana P, et al. Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial[J]. Arch Dis Child Fetal Neonatal Ed, 2010, 95(2): F85-F89. DOI: 10.1136/adc.2009.169219.
[9]	代玉静，苏艳霞，佟丽. 双水平气道正压通气序贯治疗早产儿呼吸窘迫综合征的疗效[J]. 中国新生儿科杂志，2015, 30(1): 56-58. DOI: 10.3969/j.issn.1673-6710.2015.01.015.
[10]	Rong ZH, Li WB, Liu W, et al. Nasal bi-level positive airway pressure (BiPAP) versus nasal continuous positive airway pressure (CPAP) in preterm infants ≤32 weeks: a retrospective cohort study[J]. J Paediatr Child Health, 2016, 52(5): 493-498. DOI: 10.1111/jpc.13175.
[11]	Aquilano G, Galletti S, Aceti A, et al. Bi-level CPAP does not change central blood flow in preterm infants with respiratory distress syndrome[J]. Ital J Pediatr, 2014, 40: 60. DOI: 10.1186/1824-7288-40-60.
[12]	蔡燕，王三南. 鼻塞持续呼吸道正压通气和双相呼吸道正压通气治疗新生儿轻中度呼吸窘迫综合征对氧交换指标的影响[J]. 中华实用儿科临床杂志，2014, 29(24): 1881-1885. DOI: 10.3760/j.issn.2095-428X.2014.24.011.
[13]	O′Brien K, Campbell C, Brown L, et al. Infant flow biphasic nasal continuous positive airway pressure (BP-NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants′ ≤1 250 grams: a randomized controlled trial[J]. BMC Pediatr, 2012, 12: 43. DOI: 10.1186/1471-2431-12-43.
[14]	Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network[J]. Pediatrics, 2010, 126(3): 443-456. DOI: 10.1542/peds.2009-2959.
[15]	Kirpalani H, Millar D, Lemyre B, et al. A trial comparing noninvasive ventilation strategies in preterm infants[J]. N Engl J Med, 2013, 369(7): 611-620. DOI: 10.1056/NEJMoa1214533.

[1]	Zhichao Yang, Zhi Song, Xianghong Peng, Deyu Ji. Clinical observation of fiberoptic bronchoscopy in patients undergoing continuous positive airway pressure and high-flow humidification cannula oxygen therapy[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(03): 195-199.
[2]	Jingfang Zhai, Jiebin Wu, Xiao Liu, bao Jin, Yanbo Wang, Yang Chen, Yun Wang, Guangling Zhou, Bin Zhou. Application of noninvasive high frequency oscillation ventilation in initial respiratory support of very low birth weight premature infants with respiratory distress syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(05): 598-605.
[3]	Fudong Wang, Mingfeng Fu, Minhua Chen, Mingfu Wu, Xiangfang Song, Li Zhang, Feng Liu, Lijun Jiang. Clinical research of different pulmonary surfactant administration techniques on premature infants with respiratory distress syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(03): 299-308.
[4]	Li Liu, Jun Tang. Current status of prevention and treatment of neonatal meconium aspiration syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(03): 249-256.
[5]	Bao Jin, Xiangyu Gao, Bo Yang, Di Huang, Yi Ren. Clinical research of caffeine citrate combined with heated humidified high-flow nasal cannula for prevention of extubation failure in premature infants with respiratory distress syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(06): 695-702.
[6]	Jingfang Zhai, Jiebin Wu, Bao Jin, Xiao Liu, Yanbo Wang, Guangling Zhou, Xiaoyu Song, Ke Wang, Bin Zhou, Kai Wang. Comparison of heated humidified high flow nasal cannula and nasal continuous positive airway pressure in initial respiratory support of mild neonatal respiratory distress syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(06): 632-638.
[7]	Wenxing Li, Jun Tang, Chao Chen, Xia Qiu, Yan Yue, Yan Zeng, Yi Qu, Dezhi Mu. Comparison of heated humidified high-flow nasal cannula and nasal continuous positive airway pressure in preventing extubation failure in preterm infants: a Meta-analysis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(02): 171-179.
[8]	Bao Jin, Xiangyu Gao, Bo Yang, Di Huang, Xiuhui Ma, Min Su. Caffeine citrate combined with duo positive airway pressure in treatment of premature infants with respiratory distress syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(06): 656-662.
[9]	Wen Han, Yong Xie, Xiaoying Feng, Liming Yin, Yongli Xuan, Xiaolei Yang, Xinxia Hai. Clinical application of optimization strategy of early respiratory support in the management of respiratory distress syndrome-high-risk premature infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(06): 710-714.
[10]	Juan Zou, Yuqing Liu, Yuanyuan Wan. Efficacy of BiPAP non-invasive ventilator in the treatment and cure of acute exacerbation of pulmonary heart disease and its effects on serum NT-proBNP, arterial blood gas indicators and pulmonary function[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(01): 6-10.
[11]	Shijun Wen, Yunhuan Zhang, Chengyuan Li. Value of PS combined with bi-level continuous positive airway pressure in the treatment of preterm infants with NRDS[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(06): 755-759.
[12]	Junlan Li, Xiaorong Zhang. Effect of pulmonary surfactant combined with NCPAP on serum ET-1 and CC16 in neonates with respiratory failure[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(05): 623-627.
[13]	Wenjun Li, Qibin Tang, Hong Chang, Feng Gao, Kailyu Wang. Effects of tiotropium bromide assisted bilevel positive airway pressure ventilation on the levels of serum MMP-9 and TNF-α in patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(06): 718-722.
[14]	Xiufen Zhu, Biling Wei, Huifang Zheng, Linfang Ding, Zimeng Xu, Wenxuan Yu, Hao Yuan, Zhenan Chang, Zhikun Huang, Zimeng Liu. Effects of T-piece and PSV spontaneous breathing trials on clinical outcomes after successful weaning in critically ill patients: a retrospective cohort study[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 54-61.
[15]	Chun Pan, Qin Sun, Haibo Qiu, Ling Liu. Acute respiratory distress syndrome and mechanical ventilation concept: rethinking and progress in 2019[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(02): 120-123.

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