Nasal Jet-CPAP (variable flow) versus Bubble-CPAP in preterm infants with respiratory distress: an open label, randomized controlled trial

Objective:to compare the failure rates between jet continuous positive airway pressure device (j-cpap-variable flow) and bubble continuous positive airway device (b-cpap) in preterm infants with respiratory distress.study design:preterm newborns <34 weeks gestation with onset of respiratory distress within 6 h of life were randomized to receive j-cpap (a variable flow device) or b-cpap (continuous flow device). a standardized protocol was followed for titration, weaning and removal of cpap. pressure was monitored close to the nares in both the devices every 6 hours and settings were adjusted to provide desired cpap. the primary outcome was cpap failure rate within 72 h of life. secondary outcomes were cpap failure within 7 days of life, need for surfactant post-randomization, time to cpap failure, duration of cpap and complications of prematurity. an intention to treat analysis was done.results:one-hundred seventy neonates were randomized, 80 to j-cpap and 90 to b-cpap. cpap failure rates within 72 h were similar in infants who received j-cpap and in those who received b-cpap (29 versus 21%; relative risks 1.4 (0.8 to 2.3), p=0.25). mean (95% confidence intervals) time to cpap failure was 59 h (54 to 64) in the jet cpap group in comparison with 65 h (62 to 68) in the bubble cpap group (log rank p=0.19). all other secondary outcomes were similar between the two groups.conclusion:in preterm infants with respiratory distress starting within 6 h of life, cpap failure rates were similar with jet cpap and bubble cpap.