Comparison of Bubble CPAP versus conventional ventilation in Neonates having Respiratory Distress

Abstract

Objective: The purpose of this study was to compare the outcome of bubble CPAP against ventilatory CPAP in neonates having respiratory distress.

Study design:  Randomized controlled trial study.

Place and duration of study: Department of Neonatology, Children Hospital, Pakistan Institute of Medical Sciences (PIMS) Islamabad for six months from 01-03-21 to 31-08-21.

Patients and method: It is a randomized controlled trial study conducted at the Department of Neonatology, Children Hospital, PIMS Islamabad for six months from 01-03-21 to 31-08-21. The study included a total of 150 neonates of either gender presenting with respiratory distress delivered at >32 weeks and weighing >1500 grams. Demographic details (name, age, gender, gestational age at delivery, birth weight, and Silverman Score) were noted. Then neonates were divided into two groups by using the lottery method. Treatment failure was defined as the neonate failing to maintain a SpO2 greater than 90% or an arterial partial pressure (PaO2) greater than 50 mmHg with a maximal CPAP of >7cm of water and a FiO2 greater than 0.6, or necessitating mechanical ventilation.

Results: In our study, we included a total of 150 neonates, 75 in each group. Total males were 82 (54.7%) and females 68 (45.3%) with a male-to-female ratio of 1.2:1. The mean gestational age was 36±2.49 and 35.52±1.36 weeks in bubble continues positive airway pressure (B-CPAP), and ventilator continuous positive airway pressure (V-CPAP) groups. The mean birth weight was 2381±506.4 grams and 2187.3±427.49 grams in B-CPAP and V-CPAP groups, respectively. Ten (13.3%) patients out of 75 in B-CPAP and 19 (25.3%) in the V-CPAP group were labeled as treatment failure as per operational definition. Although the failure rate was slightly higher in patients having Ventilatory CPAP as a resuscitation for respiratory distress, these results were statistically not significant (p-value= 0.052).

Conclusion: In the treatment of respiratory distress, there is no difference in the failure rate of bubble CPAP and ventilatory CPAP. Regardless of the patient's gender, birth weight, gestational age, or Silverman score, bubble CPAP may be considered a primary mode of respiratory support in neonates with respiratory distress.

Keywords: Bubble continuous positive airway pressure, Mechanical ventilation, Neonate, Respiratory distress syndrome, respiratory failure, ventilator continuous positive airway pressure.