Abstract 1154 Poster Session I, Saturday, 5/1 (poster 25)

A high proportion of VLBW infants fails extubation. We have previously described the technique of NP-SIMV as a non-invasive means of providing respiratory support following extubation (Pediatr Research 41:258A, 1997). To prospectively compare the incidence of post-extubation respiratory failure, we randomized 41 VLBW infants to NP-SIMV or to NP-CPAP at the time of extubation. Primary outcome was respiratory failure requiring reintubation at 48 hours post-extubation defined as pH<7.25 on 2 blood gases drawn 30 minutes apart, PCO2 25% above preextubation value, FiO2>0.50 to keep oxygen saturation between 92 and 95%, and/or recurrent apnea and bradycardia requiring bag and mask ventilation. Twenty-two infants were randomized to NP-SIMV (mean BW=963 g, GA=28 wks) and 19 infants to NP-CPAP (mean BW-944 g, GA=28wks). Median length of intubation and weight at extubation were similar among the 2 groups (NP-SIMV = 18.5 days, 1198g; NP-CPAP = 21 days, 1175g). There were no significant differences between the two groups in demographics, severity of initial illness, complications, and ventilatory management prior to extubation. The incidence of post-extubation respiratory failure in NP-SIMV group was 5% as compared to 37% in the NP-CPAP group (p=0.016) at 48 hours post-extubation. We conclude that NP-SIMV applied to VLBW infants at the time of extubation is more effective in decreasing the incidence of post-extubation failure rate than NP-CPAP.

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