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

Abstract

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.

Noninvasive Respiratory Support in Neonates: A Review of Current Evidence and Practices

“…Neonates managed on bCPAP are noted to be at decreased risk of CPAP failure [odds ratio (OR) 0.75; 95% CI 0.57–0.98]. However, they are more likely to have nasal injury, and there was no difference in clinically important outcomes of BPD or mortality [ 14 ]. When compared with hood box oxygen, nCPAP use in neonates with meconium aspiration syndrome (MAS) has shown to reduce need for MV, surfactant therapy, and duration of oxygen therapy.…”

Efficacy of noninvasive respiratory support modes as postextubation respiratory support in preterm neonates: A systematic review and network meta‐analysis

“…VF-CPAP has been shown to decrease the work of breathing when compared to CF-CPAP. 60 A recent systematic review by Bharadwaj et al 9 had demonstrated that bCPAP was more effective in preventing treatment failure when compared to other forms of CPAP. 8 This meta-analysis differs from the present NMA in that the enrolled subjects received the NRS modality as both primary support as well as postextubation support.…”

“…Although various systematic reviews have been published in the literature till date comparing some of these NRS modalities for postextubation support, none have evaluated them systematically in a network meta-analysis (NMA). [9][10][11] Also, there is paucity of evidence comparing certain The protocol was registered with PROSPERO (CRD42020193944).…”

“…Synchronization is another factor that can alter the efficacy of these devices. Although various systematic reviews have been published in the literature till date comparing some of these NRS modalities for postextubation support, none have evaluated them systematically in a network meta‐analysis (NMA) 9‐11 . Also, there is paucity of evidence comparing certain NRS modalities when used as postextubation support such as BiPAP vs HFNC, Synchronized NIPPV (S‐NIPPV)/nonsynchronized NIPPV (NS‐NIPPV) vs HFNC and S‐NIPPV vs NS‐NIPPV.…”

Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

“…A recent systematic review and meta-analysis of studies comparing bubble CPAP vs. other forms of CPAP showed less CPAP failure with the use of bubble CPAP compared to ventilator CPAP, and no difference between bubble CPAP and infant flow CPAP. However, there was no significant difference in the outcome of BPD (8 studies, 816 participants, relative risk or RR 0.8, 95% confidence interval or CI 0.53 to 1.21) [37]. Some centers in the US with seasoned experience using bubble NCPAP have demonstrated success, with low NCPAP failure and low BPD rates [38].…”