Efficacy of non-invasive respiratory support modes for primary
respiratory support in preterm neonates with Respiratory Distress
Syndrome: Systematic review and network meta-analysis.
Abstract
Objectives: To compare the efficacy of different non-invasive
respiratory support modes for primary respiratory support of preterm
infants with Respiratory Distress Syndrome (RDS). Design: Systematic
review and network meta-analysis using the Bayesian random effects
approach. MEDLINE, EMBASE and CENTRAL were searched. Interventions :
HFNC (High Flow Nasal Cannula), CPAP (Continuous Positive Airway
Pressure), BiPAP (Bilevel CPAP), NIPPV (Non Invasive Positive Pressure
Ventilation). Main outcome measures: Requirement of invasive mechanical
ventilation, any treatment failure. Results: 34 studies including 3994
patients were included. NIPPV was more effective in decreasing the
requirement of mechanical ventilation than CPAP {RR [95% Credible
Interval (CrI)] - 0.60 (0.44, 0.79)}and HFNC [0.66 (0.43, 0.99)].
Surface under the cumulative ranking curve (SUCRA) for NIPPV, BiPAP,
HFNC and CPAP were 0.94, 0.59, 0.32 and 0.13. For the outcome of
treatment failure, both NIPPV and BiPAP were more efficacious compared
to CPAP and HFNC {0.56 (0.44, 0.71) [NIPPV vs CPAP], 0.69 (0.51,
0.93) [BiPAP vs CPAP], 0.42 (0.30, 0.63) [NIPPV vs HFNC], 0.53
(0.35, 0.81) [BiPAP vs HFNC]}. The SUCRA for NIPPV, BiPAP, CPAP and
HFNC were 0.96, 0.70, 0.32 and 0.01. NIPPV was associated with a reduced
risk of air leak compared to BiPAP and CPAP [0.36 (0.16, 0.73);
0.54(0.30, 0.87), respectively]. NIPPV resulted in lesser incidence of
BPD or mortality when compared to CPAP [0.74 (0.52, 0.98)]. Nasal
injury was lesser with HFNC compared to CPAP [0.15 (0.01, 0.60)].
Conclusions: Most effective primary mode of non-invasive respiratory
support in preterm neonates with RDS was NIPPV.