Retiro temprano vs. tardío del CPAP en recién nacidos prematuros de 26-30 semanas de gestación con antecedente de síndrome de dificultad respiratoria y aplicación de surfactante

Abstract

Introduction

Currently, the initial ventilatory treatment of preterm infants with respiratory distress syndrome consists of applying CPAP. The results of studies like COIN, CURPAP and SUPPORT highlight the benefits of its use. CPAP should be maintained until clinical and gasometric stability is achieved; however, some authors suggest that continuing it until 36 weeks of corrected gestational age may favour the lung growth that was delayed due to premature birth.

Material and methods

A retrospective study was conducted to compare clinical and ventilatory outcome of preterm infants (26-30 corrected gestational age) treated using the INSURE (intubate-surfactant-extubate) technique, divided into 2 groups: early (A < 24 h) vs. late withdrawal (B > 24 h and < 72 h) after having achieved clinical and gasometric stability.

Results

A total of 51 patients were included. When CPAP was withdrawn for the first time, there were no differences in any variable; however, patients who required mechanical ventilation for a second time showed significant differences in the days with mechanical ventilation (p = .008).

Conclusions

Prolonging CPAP after having achieved clinical and gasometric stability did not benefit ventilation or oxygenation; however when used for more than 24 h in the group of patients who required mechanical ventilation for a second time, the total days of mechanical ventilation decreased.