A randomised controlled trial of two methods of delivering nasal continuous positive airway pressure after extubation to infants weighing less than 1000 g: binasal (Hudson) versus single nasal prongs

Objectives-Primary: to determine whether nasal continuous positive airway p ressure (CPAP) delivered through binasal prongs results in a greater propor tion of extremely low birthweight infants being successfully extubated, aft er a period of intermittent positive pressure ventilation, than nasal CPAP delivered by a single nasal prong. Secondary: to evaluate the effect of mod e of delivery of nasal CPAP after extubation on the need for endotracheal r eintubation, weight gain, rates of feeding intolerance, sepsis, suspected s epsis, cranial ultrasound abnormalities, retinopathy of prematurity, chroni c lung disease, and the duration of assisted ventilation and care in the te rtiary neonatal unit. Design and setting-Randomised, controlled, clinical trial conducted at the neonatal intensive care unit of the Royal Women's Hospital, Melbourne, Aust ralia. Patients-Infants of birth weight less than 1000 g, ventilated, requiring < 50% oxygen and ventilator rate less than or equal to 20/minute, and conside red by the clinical management team to be ready for extubation. Intervention-Infants were randomly allocated to receive nasal CPAP delivere d through binasal (Hudson) prongs or a single nasal prong. Primary outcome measure-Failure of extubation as defined by the following criteria: (a) apn oea (more than one episode! hour over a six hour period or one episode requ iring bag and mask ventilation); (b) absolute increase in oxygen requiremen t greater than 15% above that required before extubation; (c) respiratory a cidosis (pH < 7.25 with PCO2 > 6.67 kPa). Results-Ten of the 41 (24%) infants randomised to binasal prongs reached pr edetermined failure criteria compared with 26 of the 46 (57%) infants rando mised to a single nasal prong (p = 0.005). Four of 17 (24%) infants of birt h weight less than 800 g extubated to binasal prongs reached failure criter ia compared with 14 of 16 (88%) extubated to a single nasal prong (p < 0.00 1). There were no significant differences in any of the secondary outcomes. Conclusions-For extremely low birthweight infants ventilated using an endot racheal tube, nasal CPAP delivered through binasal (Hudson) prongs is more effective in preventing failure of extubation than that delivered through a single nasal prong.