Application Of Two Kinds Of Non-invasive Positive Pressure Ventilation As A Mode Of Ventilation In Neonatal Respiratory Distress Syndrome:a Randomized Controlled Trial

Objective:In order to further understand the application of various non-invasive positive pressure ventilation modes, we compared the advantages and disadvantages of two modes as a primary mode of ventilation in premature infants with NRDS.Method:From February 2013 to January 2015,72 preterm infants with NRDS who received intubation-pulmonary surfactant(PS)-extubation in our NICU were randomly divided(by means of random number table)into two groups based on the primary mode of ventilation; heated humidified high flow nasal cannula[HHFNC, n=35, male/female ratio was 22/13, mean gestational age(GA) was (32.0±2.2)weeks, mean birth weight(BW) was (1532±318.1)g], and nasal continuous positive airway pressure[NCPAP, n=37, male/female ratio was 22/15, GA was (31.6±2.1)weeks, BW was (1566±356.3)g]. Ventilation settings including FiO2 were adjusted according to transcutaneous SpO2 monitoring or blood gas analysis. Various settings and adverse events were recorded as well.Result:There were 35 cases in the HHFNC group, and 37 cases in the NCPAP group. Both group were no statistically significant difference in gender, delivery mode, birth weight, gestational age,5 min Apgar, admission date, PS application time after birth, CLASS Ⅱ&Ⅲ NRDS distribution in the two groups(P>0.05).Both HHFNC and NCPAP could reduce the inspiratory oxygen concentration(P<0.05), but there was no significant difference in two group(P>0.05). There was no significant difference in PaO2 and PaCO2 in two groups at the beginning of the treatment(0h).12h,24h, and 72h after the treatment(P>0.05), PaO2 of the HHFNC group and the NCPAP group have been significantly improved(P<0.05). There is statistical significance in the comparison differences at different time within each group(P<0.05), but no statistical significance in the differences at different time between the two groups(P>0.05). P/F、a/APO2 and SaO2 for both the HHFNC group and the NCPAP group have been improved, but there is no statistical significance in the differences of P/F、a/APO2 and SaO2 between the two groups(P<0.05). Compared with the NCPAP group(82.16、23.80h,111.55、29.15h), the ventilator application time(75.08、21.54h) and the oxygen therapy time(99.68、26.01h) of HHFNC group are significantly shortened, and there is statistical significance in the differences(P<0.05). There is no statistical significance in the comparison differences in length of hospital and total cost of hospitalization(P>0.05). Compared with the NCPAP group, the incidence of abdominal distention(2.9%) and nose injury(5.7%) for the HHFNC group is lower, and there is statistical significance in the differences (P<0.05); there is no statistical significance in the comparison differences in intracranial hemorrhage, air leak, bronchopulmonary dysplasia incidence, repositioning of the cannula and mortality rate(P>0.05).Conclusion:As the primary mode of ventilation in premature infants with NRDS, both HHFNC and NCPAP could effectively improve oxygenation and reduce CO2 retention. HHFNC reduced the incidence of nose injury and abdominal distention, shortened the ventilator application time and the oxygen therapy time, improved the prognosis.