Abstract: "Comparison of the Effects of Vapotherm
and Nasal CPAP in Respiratory Distress in Pre-Term Infants -
Abstract presented at the Pediatric Academic Societies Meeting
in Washington, USA, May 2005".
Authors: Gayathri Nair, Padamani Karna. Department
of Pediatrics and Human Development, Michigan State
University, East Lansing, MI, USA.
Background: "Continuous positive airway pressure
(CPAP), a treatment for respiratory distress in spontaneously
breathing neonates, is known to be associated with nasal
trauma and difficulties with its use in extremely low birth
weight (ELBW) infants. Experience with the recently
commercialised Vapotherm (VT) 2000i, a high flow system for
neonatal respiratory care, is limited"
Objective: "We hypothesised that VT provides as
effective respiratory support as bubble CPAP without potential
side effects like nasal injury. The primary objective of this
study was to compare the respiratory failure rate of VT with
bubble CPAP in preterm infants during the first 7 days of
life. Respiratory failure was defined as a blood gas with
>= 2 of the following : pH <= 7.25; pCO2 >60 (ABG) or
>65 (CBG); FI02 >70%; and frequent apnea or
bradycardia".
Design / Methods: Infants 27-34 weeks GA admitted to
the NICU after May 2004 and requiring CPAP in the first 6
hours of life were included in this study. Infants were
started on CPAP initially and randomised into a VT and a CPAP
group after parental consent. Infants with no spontaneous
respiration, major congenital anomalies or birth asphyxia
(Apgar score <3 @ 5 minutes of age) were excluded from the
study. Data was analysed using Chi-Square and t-tests".
Results: "A total of 28 infants were included in the
study: VT (n=13) and CPAP (n=15). The two groups were
clinically similar as indicated by Apgar scores, exposure to
prenatal steroids, SNAPPE II scores and FIO2 at the time of
randomisation. There was no significant difference between the
groups in respiratory failure rate during the study period
(Table 1). No infants in either group suffered nasal injury".
Table 1:
- "Vapotherm VT (n=13) and CPAP (n=15)"
- "Gestational Age (weeks) VT=32+/-0.5 and CPAP=31+/-0.5"
- "Birth weight (grams) VT=1675+/-139 and CPAP=1493+/-64"
- "SNAPPE II Score VT=11+/-1.5 and CPAP=10+/- 1"
- "RDS needing Survanta (rescue) VT= 5(39) and CPAP =
7(47)"
- "FI02 @ Randomisation % VT=40+/-3 and CPAP=45+/-5"
- "Respiratory Support Average Duration (hours) VT=57+/-14
and CPAP=67+/-13"
- "Respiratory Failure VT=2(13) and CPAP=2 (15)"
- "Successful Weaning from Respiratory Support VT=11(85)
and CPAP= 12(80)"
- "*Mean +/- SEM, Number Parentheses = %"
Conclusions: "VT appears to provide as effective
respiratory support as CPAP in the initial treatment of
respiratory distress. Efficacy of VT in reducing potential
side effects, such as nasal injury and pneumothorax, awaits
similar trials in infants on long term ventilatory support".
Note: We await the presentation and publication of
results from prospective, randomised, controlled studies
currently underway in Australia and overseas comparing
Vapotherm to nasal CPAP.
