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'Flow driver' CPAP good for apnea of prematurity.

RANCHO MIRAGE, CALIF. -- A head-to-head comparison of four nasal continuous positive airway pressure devices for apnea of prematurity indicated that devices employing "infant flow driver" technology are significantly superior to a standard intermittent mechanical ventilation device and are at least as good as an underwater bubble system.

In a randomized controlled trial involving 16 infants with a median gestational age of 28 weeks, each of the infants was tried on four study systems in a random order, with each study system being used for a period of 6 hours, yielding a total study duration of 24 hours per patient, Dr. Tobias Pantalitschka and colleagues of University Hospital Tubingen (Germany) reported in a poster presentation at a conference on sleep disorders in infancy and childhood, sponsored by the Annenberg Center for Health Sciences.

The main outcome measure was the number of bradycardia and oxygen-desaturation events per hour. While the infants were on standard intermittent positive-pressure ventilation (Stephanie ventilator from Stephan GmbH, Germany), they experienced a median of 6.7 events per hour. With an underwater bubble continuous positive airway pressure (CPAP) system, they experienced a median of 5.4 events per hour. With the Infant Flow Driver (Electro Medical Equipment Ltd., East Sussex, England), the median was 2.8 events per hour, and with the Infant Flow Advanced System (also Electro Medical Equipment Ltd.) in pressure-assist mode, the median was 4.4 events per hour.

The two Infant Flow systems were significantly better than the standard device on this measure. The two Infant Flow systems did not differ significantly from one another or from the underwater bubble CPAP, and the underwater bubble CPAP did not differ significantly from the standard system.

There were no significant differences on any of the secondary measures, including the number of apneas per hour, the mean apnea duration, and the total event duration per hour. The infant flow devices are designed to reduce the amount of effort that premature infants must expend to breathe. Other studies have shown that, compared with conventional CPAP devices, infant flow devices result in a reduced oxygen requirement, decrease the work of breathing, and sometimes decrease extubation failure.

The investigators expressed surprise that the two infant flow devices did not differ significantly from one another. The pressure assist mode used in the Infant Flow Advance system in effect provides both CPAP and intermittent mechanical ventilation, and the investigators expected this device to be superior. That expectation was bolstered by a recent Cochrane review showing that noninvasive positive-pressure ventilation was more effective than nasal CPAP in preventing extubation failure.

The investigators hypothesize that their failure to find a difference may have been because they used the infant flow devices without synchronization. They chose not to use synchronization because the standard device offered no synchronization with nasal ventilation, and they wanted to keep all system settings as similar as possible.

The investigators disclosed no conflicts of interest related to their presentation.


San Francisco Bureau

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Title Annotation:Clinical Rounds; continuous positive airway pressure
Author:Finn, Robert
Publication:Pediatric News
Date:Apr 1, 2007
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