“Hemodynamic effects of nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure in preterm neonates following extubation: a randomized controlled trial”

Nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) are two commonly used modalities of non-invasive respiratory support in neonatal intensive care units. Although both are effective, NIPPV is increasingly preferred because of its additional clinical advantages. However, the comparative hemodynamic effects of these strategies remain uncertain. This randomized controlled trial aimed to compare the hemodynamic effects of NIPPV and NCPAP in preterm infants following extubation.

In this single-center randomized controlled trial, preterm neonates (26–36^+ 6 weeks), previously intubated and treated with surfactant, were randomized to NIPPV or NCPAP following extubation. Functional echocardiography (FnECHO) was performed at 4–6 h and 18–24 h to assess right and left ventricular output (RVO, LVO) and indices of systolic and diastolic function.

Sixty preterm neonates were included in the final analysis (30 in each group). Baseline RVO and LVO on invasive mechanical ventilation were comparable between the groups (p = 0.33, 0.53). Post-extubation, infants on NIPPV demonstrated significantly lower cardiac outputs than those on NCPAP at 4–6 h (RVO, p = 0.006; LVO, p = 0.001) and at 18–24 h (RVO, p < 0.001; LVO, p < 0.001). After adjustment for gestational age and birth weight, these differences remained significant. Sensitivity analysis adjusting for baseline oxygen saturation index attenuated the early differences, whereas those at 18–24 h remained significant (RVO p = 0.030; LVO p = 0.022). Despite statistical significance, all values remained within gestational age-appropriate physiological limits. Mean airway pressure was significantly higher in the NIPPV group at 4–6 h (10.35 ± 1.0 vs. 6.16 ± 1.2 cm H₂O) and 18–24 h (9.72 ± 1.3 vs. 5.71 ± 1.6 cm H₂O; both p < 0.001) and showed a significant inverse correlation with cardiac outputs.

Neonates supported with NIPPV in the post-extubation period demonstrated lower cardiac outputs compared with those on NCPAP, and this was associated with higher mean airway pressures. Although within physiological limits, these changes warrant hemodynamic monitoring and further evaluation of their clinical impact.

This study was prospectively registered with the Clinical Trials Registry of India (CTRI/2024/04/065278) on 05 April 2024. Trial details are publicly accessible at https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=78,344.