Effects on respiration of CPAP immediately after extubation in the very preterm infant

Abstract

The effects of continuous positive airway pressure (CPAP) on pulmonary function during weaning from ventilator treatment were examined immediately after extubation in 17 very preterm infants, who had been ventilator-treated because of hyaline membrane disease (15 infants) and chronic pulmonary insufficiency of prematurity (two infants). Seven infants had bronchopulmonary dysplasia. Median birthweight was 920 g and median gestational age 26 completed weeks. The median duration of ventilator treatment was 10 days. Application of CPAP by means of a face chamber device after endotracheal extubation significantly lowered the frequency of apnea (P = 0.02) and enhanced oxygenation (P = 0.001). The respiratory mechanical indices derived from flow rate and juxta-diaphragmatic esophageal pressure measurements showed a reduced elastic (P = 0.03) and resistive (P = 0.02) load on the diaphragm. Even if the measured values do not accurately represent absolute resistances and compliances, the relative values of end-inspiratory and end-expiratory pressures differed significantly with and without CPAP (P = 0.001 and 0.002, respectively). We found CPAP applied via the face chamber technique immediately after extubation to be beneficial and to facilitate weaning from ventilator treatment in very preterm infants.