Skip to main content
 

Main menu

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Archives
    • Most-Read Papers of 2022
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2023 Call for Abstracts
    • 2022 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
American Association for Respiratory Care
  • Subscribe
  • My alerts
  • Log in
American Association for Respiratory Care

Advanced Search

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Archives
    • Most-Read Papers of 2022
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2023 Call for Abstracts
    • 2022 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal
  • Twitter
  • Facebook
  • YouTube
EditorialEditorials

Strategies to Reduce Mechanical Ventilation and Bronchopulmonary Dysplasia in Preterm Infants

Nelson Claure, Jose Antonio Bello and Deepak Jain
Respiratory Care July 2013, 58 (7) 1257; DOI: https://doi.org/10.4187/respcare.02595
Nelson Claure
Division of Neonatology Department of Pediatrics University of Miami Miller School of Medicine Miami, Florida
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: [email protected]
Jose Antonio Bello
Division of Neonatology Department of Pediatrics University of Miami Miller School of Medicine Miami, Florida
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Deepak Jain
Division of Neonatology Department of Pediatrics University of Miami Miller School of Medicine Miami, Florida
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • References
  • PDF
Loading

Bronchopulmonary dysplasia (BPD) continues to be one of the common complications of premature birth. The paper by Freidman et al in this issue of Respiratory Care shows the effectiveness of establishing a balanced approach to reduce the exposure to mechanical ventilation, with the ultimate goal of reducing the incidence of BPD in premature infants of very low birth weight.1

As evidenced by the recent trials, a large proportion of infants can be adequately managed with CPAP, with comparable rates of BPD to those achieved in mechanically ventilated infants.2,3 These trials also made clear that a significant proportion of infants initially started on CPAP eventually require mechanical ventilation, which was more evident among infants of lower gestational age. In the cohort reported by Friedman et al, 60% of VLBW infants required ventilation on day 1, and more than 30% on day 7. Hence, once the infants are intubated and placed on mechanical ventilation, the respiratory care strategy becomes increasingly relevant.

In this cohort the proportion of extubation failure in the first era, when ventilator driven CPAP was used, was similar to that in the second era, when bubble CPAP was used after extubation. This is in agreement with existing data from clinical trials that showed none of the CPAP delivery methods offers advantages over the rest in reducing extubation failure.4,5

To manage ventilated infants, Friedman et al established a combined approach of surfactant administration with immediate extubation (the INSURE strategy) as well as a weaning protocol for rapid extubation to bubble CPAP, and a reintubation protocol for those infants failing extubation. In addition, the authors report an increased use of vitamin A, and reduced rates of ductal ligation in the second era. The authors demonstrate the association between this combined approach and the observed reduction in the duration of mechanical ventilation and the incidence of BPD.

Although this study has the known limitations of a retrospective data analysis, it underlines the fact that prevention of BPD requires a multifaceted strategy. This study also reminds us that, following the institution of strategies to improve one outcome, it is prudent to monitor for the occurrence of unexpected increases in morbidities or mortality.

Footnotes

  • Correspondence: Nelson Claure MSc PhD, Division of Neonatology, Department of Pediatrics, PO Box 016960, R-131, University of Miami, Miami FL 33101. E-mail: nclaure{at}miami.edu.
  • The authors have disclosed no conflicts of interest.

  • See the Original Study on Page 1134

  • Copyright © 2013 by Daedalus Enterprises

References

  1. 1.↵
    1. Friedman CA,
    2. Menchaca RC,
    3. Baker MC,
    4. Rivas CK,
    5. Laberge RN,
    6. Rios EH,
    7. et al
    . Bubble nasal CPAP, early surfactant treatment, and rapid extubation are associated with decreased incidence of bronchopulmonary dysplasia in very-low-birth-weight newborns: efficacy and safety considerations. Respir Care 2012;58(7):1134-1142.
    OpenUrl
  2. 2.↵
    1. Finer NN,
    2. Carlo WA,
    3. Walsh MC,
    4. Rich W,
    5. Gantz MG,
    6. Laptook AR,
    7. Yoder BA,
    8. et al
    . Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010;27;362(21):1970-1979.
    OpenUrl
  3. 3.↵
    1. Morley CJ,
    2. Davis PG,
    3. Doyle LW,
    4. Brion LP,
    5. Hascoet JM,
    6. Carlin JB
    ; COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008;14;358(7):700-708.
    OpenUrl
  4. 4.↵
    1. Gupta S,
    2. Sinha SK,
    3. Tin W,
    4. Donn SM
    . A randomized controlled trial of post-extubation bubble continuous positive airway pressure versus Infant Flow Driver continuous positive airway pressure in preterm infants with respiratory distress syndrome. J Pediatr 2009;154(5):645-650.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Stefanescu BM,
    2. Murphy WP,
    3. Hansell BJ,
    4. Fuloria M,
    5. Morgan TM,
    6. Aschner JL
    . A randomized, controlled trial comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants. Pediatrics 2003.;112(5):1031-1038.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Respiratory Care: 58 (7)
Respiratory Care
Vol. 58, Issue 7
1 Jul 2013
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Monthly Podcast

 

Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Association for Respiratory Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Strategies to Reduce Mechanical Ventilation and Bronchopulmonary Dysplasia in Preterm Infants
(Your Name) has sent you a message from American Association for Respiratory Care
(Your Name) thought you would like to see the American Association for Respiratory Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Strategies to Reduce Mechanical Ventilation and Bronchopulmonary Dysplasia in Preterm Infants
Nelson Claure, Jose Antonio Bello, Deepak Jain
Respiratory Care Jul 2013, 58 (7) 1257; DOI: 10.4187/respcare.02595

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Strategies to Reduce Mechanical Ventilation and Bronchopulmonary Dysplasia in Preterm Infants
Nelson Claure, Jose Antonio Bello, Deepak Jain
Respiratory Care Jul 2013, 58 (7) 1257; DOI: 10.4187/respcare.02595
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Info & Metrics
  • References
  • PDF

Related Articles

Cited By...

Info For

  • Subscribers
  • Institutions
  • Advertisers

About Us

  • About the Journal
  • Editorial Board

AARC

  • Membership
  • Meetings
  • Clinical Practice Guidelines

More

  • Contact Us
  • RSS
American Association for Respiratory Care

Print ISSN: 0020-1324        Online ISSN: 1943-3654

© Daedalus Enterprises, Inc.

Powered by HighWire