A randomised controlled trial of flow driver and bubble continuous positive airway pressure in preterm infants in a resource-limited setting

Mazmanyan, Pavel; Mellor, Kathy; Doré, Caroline J; Modi, Neena

doi:10.1136/archdischild-2015-308464

Cited by 26 publications

(13 citation statements)

References 10 publications

(9 reference statements)

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“…Using an underwater seal to generate the pressure, or “Bubble CPAP,” generates small fluctuations around the set pressure which some believe offers additional advantage [93]. Using a flow driver to generate CPAP has the theoretical advantage of offloading expiratory work of breathing (the Coanda effect), although no important clinical differences have been shown among devices used to deliver CPAP, but the simplicity of bubble CPAP systems allows their use in low-income settings [94]. Trials comparing interfaces show no differences between nasal prongs and short pharyngeal tubes for initial stabilisation in the delivery room [50], but for prolonged use nasal masks may be most effective [95].…”

Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…We performed full-text review of 68 studies of which 47 were excluded with valid reasons (figure 1). A total of 21 studies9 11–16 19–22 28–37 were included (study characteristics shown in online supplementary file 2), of which 199 11–16 19–22 28–30 32–36 were included in meta-analyses for all outcomes and 129 12 15 16 19–21 28 30 34–36 were included in meta-analysis for the primary outcome. Of 21 studies, one article in Persian and one written in Portuguese were translated with the help of Persian and Portugal colleagues at our institution.…”

Section: Resultsmentioning

confidence: 99%

“…Of 21 studies, one article in Persian and one written in Portuguese were translated with the help of Persian and Portugal colleagues at our institution. Of the 19 studies included in the meta-analyses for all outcomes, 5 had high risk,20 22 28 30 32 8 had an unclear risk11 14 16 19 21 29 33 34 and 6 had low risk of bias9 12 13 15 35 36 as shown in figures 2 and 3. In all studies, blinding of participants and healthcare personnel could not be performed due to the nature of treatment.…”

Section: Resultsmentioning

confidence: 99%

“…The simplicity of bubble CPAP, combined with reports of favourable outcomes from centres with experience in its use, has long generated interest in this form of CPAP. There have been a number of trials comparing bubble CPAP with other CPAP forms but with heterogeneity in reported outcomes 9–16. In one recent systematic review, bubble CPAP was shown to be safe and reduced the need for mechanical ventilation, but only studies from low-income and middle-income countries were included 17.…”

Section: Introductionmentioning

confidence: 99%

“…Another systematic review showed less CPAP failure with bubble CPAP but only five studies mainly from low-income and middle-income countries were included, and study-level variables were not accounted for 18. Six newer studies have been published since this review 9 15 19–22. Due to the limitations of the aforementioned reviews, along with continued interest in this form of CPAP, we sought to systematically evaluate and meta-analyse the literature on bubble versus other forms of CPAP, regardless of country of origin.…”

Section: Introductionmentioning

confidence: 99%

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Bubble versus other continuous positive airway pressure forms: a systematic review and meta-analysis

Bharadwaj

Alonazi

Banfield

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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BackgroundUse of bubble continuous positive airway pressure (CPAP) has generated considerable interest in neonatal care, but its comparative effectiveness compared with other forms of CPAP, especially in developed countries, remains unclear.ObjectiveTo systematically review and meta-analyse short-term clinical outcomes among preterm infants treated with bubble CPAP vs all other forms of CPAP.MethodsProspective experimental studies published from 1995 onward until October 2018 comparing bubble versus other CPAP forms in preterm neonates <37 weeks’ gestational age were included after a systematic review of multiple databases using pre-specified search criteria.ResultsA total of 978 articles were identified, of which 19 articles were included in meta-analyses. Of these, 5 had a high risk of bias, 8 had unclear risk and 6 had low risk. The risk of the primary outcome (CPAP failure within 7 days) was lower with bubble CPAP (0.75; 95% CI 0.57 to 0.98; 12 studies, 1194 subjects, I2=21%). Among secondary outcomes, only nasal injury was higher with use of bubble CPAP (risk ratio (RR) 2.04, 95% CI 1.33 to 3.14; 9 studies, 983 subjects; I2=42%) whereas no differences in mortality (RR 0.82, 95% CI 0.47 to 1.92; 9 studies, 1212 subjects, I2=20%) or bronchopulmonary dysplasia (BPD) (RR 0.8, 95% CI 0.53 to 1.21; 8 studies, 816 subjects, I2=0%) were noted.ConclusionBubble CPAP may lead to lower incidence of CPAP failure compared with other CPAP forms. However, it does not appear to translate to improvement in mortality or BPD and potential for nasal injury warrants close monitoring during clinical application.Trial registration numberCRD42019120411.

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Bubble devices versus other pressure sources for nasal continuous positive airway pressure in preterm infants

Paoli

Davis

Oddie

et al. 2023

Cochrane Database of Systematic Reviews

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A randomised controlled trial of flow driver and bubble continuous positive airway pressure in preterm infants in a resource-limited setting

Abstract: ISRCTN22578364.

Cited by 26 publications

References 10 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Bubble versus other continuous positive airway pressure forms: a systematic review and meta-analysis

Bubble devices versus other pressure sources for nasal continuous positive airway pressure in preterm infants

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