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

Abstract

Background: Multiple noninvasive respiratory support (NRS) modalities are used for postextubation support in preterm neonates. Seven NRS modalities were comparedconstant flow continuous positive airway pressure (CPAP) (CF-CPAP) (bubble CPAP; ventilator CPAP), variable flow CPAP (VF-CPAP), high flow nasal cannula (HFNC), synchronized noninvasive positive pressure ventilation (S-NIPPV), nonsynchronized NIPPV (NS-NIPPV), bilevel CPAP (BiPAP), noninvasive high-frequency oscillation ventilation (nHFOV). Design: Systematic review and network meta-analysis (NMA) using the Bayesian random-effects approach. MEDLINE, EMBASE, CENTRAL, WHO-ICTRP were searched. Main Outcome Measure: Requirement of invasive mechanical ventilation within 7 days of extubation. Results: A total of 33 studies with 4080 preterm neonates were included. S-NIPPV, NS-NIPPV, nHFOV, and VF-CPAP were more efficacious in preventing reintubation than CF-CPAP (risk ratio [RR] [95% credible intervals {CrI}]: 0.

Nasal HFOV Versus Nasal IPPV as a Post Extubation Respiratory Support in Preterm Infants - a Randomised Controlled Trial

“…Need for mechanical ventilation was signi cantly reduced in many studies and two meta-analysis using nHFOV as a primary mode, however all of them used nCPAP as the comparator arm [12,16,17]. nCPAP is still considered the standard of care post extubation, while NIPPV now appears to be the better modality, with its own pitfalls [23]. nHFOV is adjudged in benchmark studies as a better respiratory support modality [4].…”

“…Only two studies have evaluated the e cacy of nHFOV post extubation [ 13 , 22 ]. SNIPPV might be the most effective non invasive respiratory support modality in the immediate post extubation phase but is not readily available [ 23 ]. Currently a large multicentric trial is being conducted in China which aims to select the superior secondary mode of non invasive ventilation amongst nCPAP, NIPPV and nHFOV [ 24 ].…”

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

“…In this study, it was noted that NIPPV resulted in lesser incidence of BPD or death when compared to other modes of frequently used non-invasive ventilation. The same authors performed another network meta-analysis (33 studies and 4080 infants) comparing different non-invasive modes used post-extubation, and concluded that the use of SNIPPV is associated with decreased BPD compared to other modes [58]. While there are no large scale RCTs showing a definite benefit with use of NIPPV to decrease BPD, there is enough evidence to recommend its use both as a primary mode, and after extubation, in preterm infants.…”

Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

“…Infants with congenital heart disease (CHD) need respiratory support after surgery because of their young age and poor independent mobility. Noninvasive ventilation (NIV) has been proven to be useful for respiratory support in pediatric patients and can effectively reduce the extubation failure rate in high-risk infants [1][2][3][4][5]. In recent years, the technique of NIV has become increasingly mature, especially the application of bilevel positive airway pressure (BiPAP) and nasal continuous positive airway pressure (NCPAP), which have signi cantly reduced the application of invasive ventilation and shortened the time of mechanical ventilation.…”

“…NIV has previously been widely used in the eld of premature babies and newborns. Studies have con rmed that BiPAP and NCPAP can be used to treat neonatal respiratory failure, respiratory distress syndrome (RDS) and reduce the incidence of bronchopulmonary dysplasia [2,[5][6][7][8]. However, few studies have focused on the application of NIV in infants with CHD after extubation.…”