Nasal intermittent positive pressure ventilation as a rescue therapy after nasal continuous positive airway pressure failure in infants with respiratory distress syndrome

OBJECTIVE: Evaluate whether nasal intermittent positive-pressure ventilation (NIPPV) as rescue therapy after initial nasal continuous positive airway (NCPAP) failure reduces need for invasive mechanical ventilation (IMV) in infants with respiratory distress syndrome (RDS). DESIGN: Retrospective cohort involving 156 preterm infants who failed initial NCPAP and were then submitted to NIPPV rescue therapy and classified into NIPPV success or failure, according to need for IMV. RESULT: Of all infants included, 85 (54.5%) were successfully rescued with NIPPV while 71 (45.5%) failed. The NIPPV success group had significantly lower rates of bronchopulmonary dysplasia, peri/intraventricular hemorrhage, patent ductus arteriosus and greater survival without morbidities (all p <= 0.01). Infants who failed NIPPV had earlier initial NCPAP failure (p= 0.09). In final logistic regression model, birthweight <= 1000 g and need for surfactant remained significant factors for NIPPV failure.CONCLUSION: NIPPV rescue therapy reduced the need for IMV in infants that failed NCPAP and was associated with better outcomes.