Positive Pressure Ventilation in Preterm Babies after Continuous Positive Airway Pressure Failure with or without a Tube? A Randomized Controlled Trial

Background: Intermittent positive pressure ventilation is a nonphysiological mode of respiratory support. Clinician‐determined parameters such as peak inspiratory pressure, positive end‐expiratory pressure, and respiratory rate will drive the gas into the lungs (driving pressure). In contrast, continuous positive airway pressure (CPAP) is a physiological mode of respiratory support where normal tidal breathing of the neonate is responsible for the movement of gas into the lungs and CPAP reduces the work of breathing by improving the functional residual capacity of the lungs. In this study, we have compared two different modes of intermittent positive pressure ventilation in babies who cannot be managed on CPAP. Objective: The objective of the study was to find out the difference in duration of the driving pressure support between NIPPV and continuous mechanical ventilation (CMV) in babies who fail CPAP. Methodology: Preterm neonates with respiratory distress who failed CPAP were randomized to either NIPPV or CMV support. The duration of driving pressure support needed in these two groups was compared. Results: The median (interquartile range) duration of driving pressure ventilation in the CMV group was 49.5 (24–71) hours and that in the NIPPV group was 48 (29.5–62.5) hours, which was not statistically significant ( P = 0.89). Conclusion: The duration of driving pressure support is similar in both NIPPV and CMV modes of ventilation in babies with respiratory distress beyond CPAP.