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Original ArticleOpen Access
A Randomized Trial of Non-Synchronized Nasopharyngeal Intermittent Mandatory Ventilation (nsNIMV) vs. Nasal Continuous Positive Airway Pressure (NCPAP) in the Prevention of Extubation Failure in Pre-term < 1,500 Grams
Khorana M 
,
Paradeevisut H ,
Sangtawesin V ,
Kanjanapatanakul W ,
Chotigeat U ,
Kasemsri Na Ayutthaya J
,
Paradeevisut H ,
Sangtawesin V ,
Kanjanapatanakul W ,
Chotigeat U ,
Kasemsri Na Ayutthaya J Objective: To compare the rate of reintubation within 7 days after extubation and study the complications in
premature infants who were randomized in the immediate postextubation period to either nsNIMV or NCPAP.
Material and Method: This study was conducted in the neonatal unit of Queen Sirikit National Institute of
Child Health between June 1 and November 30, 2006. Intubated premature infants born at GA < 34 weeks or
with birth weight <1500 gm, ready to be extubated before 4 weeks of age were recruited. Infants were
randomized to either nsNIMV or NCPAP after extubation. Non-synchronized NIMV setting was the same as
ventilator setting before extubation and NCPAP pressure was set at the same mean airway pressure of pre
extubation ventilator value. Extubation was performed after intravenous loading dose of aminophylline.
Primary outcome measurement was reintubation within 7 days of initial extubation and the secondary outcome
was possible complications such as apnea, abdominal distension, gastrointestinal (GI) perforation,
necrotizing enterocolitis (NEC), sepsis and death.
Results: A total of 70 VLBW infants were admitted to the neonatal unit during the study period. A total of 57
infants were intubated of which 48 infants were recruited for the study; 24 were in the nsNIMV group and 24
were in the NCPAP group. Infants in the nsNIMV group had mean birth weight and body weight at the start of
study less than that in the NCPAP group (984.8 + 218 vs. 1067+ 214 and 1185 + 219 vs. 1205 +191, p = 0.003,
0.02). The nsNIMV group also had a higher rate of RDS and antenatal steroid used when compared to the
NCPAP group (19/24 vs. 12/24 and 17/24 vs. 8/24, p = 0.03, 0.01). The nsNIMV group had fewer males than
in the NCPAP group (8/24 vs. 17/24, p = 0.01). Reintubation was similar in both groups but atelectasis and
sepsis were statistically significant risk factor for reintubation in NCPAP group.
There were no significant differences in treatment related complications between the two groups,
with respect to incidence of apnea (41.7% in nsNIMV vs. 62.5% in NCPAP), abdominal distensions (8.3% in
nsNIMV vs. 16.7% in NCPAP), NEC (4.2% in nsNIMV vs. 12.5 in NCPAP), sepsis (4.2% in nsNIMV vs. 8.3%
NCPAP). No GI perforation was observed in both groups.
Conclusion: Non-invasive mode of ventilation, both NIMV and NCPAP, for weaning of pre-term infants from
ventilator may reduce the rate of reintubation in this group. Both modes seem to be equally safe. We believe
that the use of non-invasive ventilator techniques will significantly reduce neonatal morbidity in the future.
Additional prospective evaluation of these approaches should be conducted in the future.
Keywords: Non-synchronized nasopharyngeal intermittent mandatory ventilation (nsNIMV), Nasal continuous
positive airway pressure (NCPAP), Extubation failure
premature infants who were randomized in the immediate postextubation period to either nsNIMV or NCPAP.
Material and Method: This study was conducted in the neonatal unit of Queen Sirikit National Institute of
Child Health between June 1 and November 30, 2006. Intubated premature infants born at GA < 34 weeks or
with birth weight <1500 gm, ready to be extubated before 4 weeks of age were recruited. Infants were
randomized to either nsNIMV or NCPAP after extubation. Non-synchronized NIMV setting was the same as
ventilator setting before extubation and NCPAP pressure was set at the same mean airway pressure of pre
extubation ventilator value. Extubation was performed after intravenous loading dose of aminophylline.
Primary outcome measurement was reintubation within 7 days of initial extubation and the secondary outcome
was possible complications such as apnea, abdominal distension, gastrointestinal (GI) perforation,
necrotizing enterocolitis (NEC), sepsis and death.
Results: A total of 70 VLBW infants were admitted to the neonatal unit during the study period. A total of 57
infants were intubated of which 48 infants were recruited for the study; 24 were in the nsNIMV group and 24
were in the NCPAP group. Infants in the nsNIMV group had mean birth weight and body weight at the start of
study less than that in the NCPAP group (984.8 + 218 vs. 1067+ 214 and 1185 + 219 vs. 1205 +191, p = 0.003,
0.02). The nsNIMV group also had a higher rate of RDS and antenatal steroid used when compared to the
NCPAP group (19/24 vs. 12/24 and 17/24 vs. 8/24, p = 0.03, 0.01). The nsNIMV group had fewer males than
in the NCPAP group (8/24 vs. 17/24, p = 0.01). Reintubation was similar in both groups but atelectasis and
sepsis were statistically significant risk factor for reintubation in NCPAP group.
There were no significant differences in treatment related complications between the two groups,
with respect to incidence of apnea (41.7% in nsNIMV vs. 62.5% in NCPAP), abdominal distensions (8.3% in
nsNIMV vs. 16.7% in NCPAP), NEC (4.2% in nsNIMV vs. 12.5 in NCPAP), sepsis (4.2% in nsNIMV vs. 8.3%
NCPAP). No GI perforation was observed in both groups.
Conclusion: Non-invasive mode of ventilation, both NIMV and NCPAP, for weaning of pre-term infants from
ventilator may reduce the rate of reintubation in this group. Both modes seem to be equally safe. We believe
that the use of non-invasive ventilator techniques will significantly reduce neonatal morbidity in the future.
Additional prospective evaluation of these approaches should be conducted in the future.
Keywords: Non-synchronized nasopharyngeal intermittent mandatory ventilation (nsNIMV), Nasal continuous
positive airway pressure (NCPAP), Extubation failure
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