RANDOMIZED TRIAL OF ELECTIVE CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) COMPARED WITH RESCUE CPAP AFTER EXTUBATION

Aim-To determine if a weaning regimen on flow driver continuous positi ve airway pressure (CPAP) would decrease the number of ventilator days but increase the number of CPAP days when compared with a rescue regi men. Methods-Fifty eight babies of 24-32 weeks gestation with respirat ory distress syndrome (RDS) were studied prospectively. After extubati on they were randomly allocated to receive CPAP for 72 hours (n=29) ac cording to a weaning regimen, or were placed in headbox oxygen and rec eived CPAP only if preset ''start CPAP'' criteria were met (n=29, resc ue group). Results-There was no difference in successful extubation at 72 hours, 1 and 2 weeks, between the groups in terms of the number of reventilation episodes, reventilation days, or in total days of CPAP. Birthweight, gestational age, race, day of first extubation, antenata l or postnatal steroids, patent ductus arteriosus status and maximal m ean airway pressure used were of no value in predicting success or fai lure at 72 hours, 1, or 2 weeks. Conclusion-The weaning regimen did no t decrease the number of ventilator days or days on CPAP compared with the rescue regimen. The rescue regimen on flow driver CPAP seems to b e a safe and effective method of managing a baby of 24-32 weeks gestat ion who has been ventilated for RDS or immature lung disease.