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Vol. 58. Núm. 4.
Páginas 350-356 (abril 2003)
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Vol. 58. Núm. 4.
Páginas 350-356 (abril 2003)
Acceso a texto completo
Presión positiva continua en la vía aérea por vía nasal en el recién nacido prematuro: estudio comparativo de dos modelos de baja resistencia
Nasal continuous positive airway pressure in preterm infants: comparison of two low-resistance models
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13736
A. Gutiérrez Laso
Autor para correspondencia
aguti@teleline.es

Correspondencia: Hospital Universitario La Fe. Unidad de Cuidados Intensivos. Servicio de Neonatología. Avda. Campanar, 21. 46009 Valencia. España.
, P. Sáenz González, I. Izquierdo Macián, C. Fernández Gilino, A. Gimeno Navarro, M. Gormaz Moreno, D. Torres Palomares, F. Morcillo Sopena, V. Roqués Serradilla
Unidad de Cuidados Intensivos. Servicio de Neonatología. Hospital Universitario La Fe. Valencia. España
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Información del artículo
Objetivo

Comparar la eficacia y seguridad de dos modelos diferentes de presión positiva continua en la vía aérea por vía nasal (CPAP-n) de baja resistencia, en recién nacidos pretérminos.

Material y métodos

Estudio prospectivo realizado en cuidados intensivos neonatales del Hospital La Fe durante un año, comparando los sistemas Infant Flow (IF) y Medijet (MJ). Se incluyeron todos los pretérminos que precisaron CPAP-n por distress respiratorio al ingreso (grupo I), postextubación en menores de 1.500 g al nacimiento (grupo II) y syndrome apneico-bradicárdico (grupo III); asignación aleatoria a uno u otro sistema.

Resultados

Estudiamos 125 pacientes, que recibieron 226 tratamientos; 126 con IF y 110 con MJ. Medias edad gestacional, 29,4 semanas, y peso al nacimiento, 1.340 g.

Eficacia. Grupo I (n _ 73): no hubo diferencias entre los 2 modelos consiguiéndose a las 6 h del inicio de CPAP-n descensos de la fracción inspiratoria de oxígeno (FiO2), presión parcial de dióxido de carbono (pCO2) y esfuerzo respiratorio; necesidad similar de intubación y ventilación (34,6 % IF y 24,1% MJ). Grupo II (n _ 73): porcentaje de reintubación semejante a 48 h (19 % IF y 8% MJ). Grupo III (n _ 80): tras 24 h de CPAP-n desaparecieron las apneas en proporción similar (46 % IF y 58 % MJ); precisaron intubación y ventilación 24 % del IF y 10 % del MJ.

Complicaciones. Escapes aéreos: 6 pacientes (4 IF y 2 MJ). Distensión abdominal grave: similar con ambos sistemas (5 %). Lesión nasal significativa: 5 pacientes (1 IF y 4 MJ).

Conclusiones

Los dos sistemas de CPAP-n han sido efectivos y seguros en los supuestos estudiados, sin diferencias significativas en los resultados.

Palabras clave:
CPAP-nasal
Síndrome apneico
Distrés respiratorio
Postextubación pretérminos
Infant flow Medijet
Objective

To compare the safety and efficacy of two low expiratory resistance models of nasal continuous positive airway pressure (n-CPAP) in preterm infants.

Material and methods

A 1-year prospective trial was performed in the Neonatal Intensive Care Unit of La Fe Hospital to compare the Infant Flow (IF) and Medijet (MJ) devices. All preterm infants requiring n-CPAP for respiratory distress at birth (group I), infants weighting less than 1500 g requiring postextubation (group II) and those with apnea-bradycardia syndrome (ABS) (group III) were included. The patients were randomly assigned to IF or MJ.

Results

A total of 125 patients received 226 treatments (IF: n _ 126: MJ: n _ 110). The mean gestational age was 29.4 weeks and the mean birth weight was 1340 g.

Efficacy. In group I (n 73) no difference were found between systems and 6 hours' after initiation of n-CPAP decreases in FiO2, CO2 and respiratory effort were similar. The need for intubation was also similar (IF: 34.6 %; MJ: 24.1%). In group II (n 73) the need for reintubation at 48 hours was similar with both treatments (IF:19 %; MJ: 8%). In group III (n 80) resolution of ABS was similar after 24 hours of n-CPAP (IF: 46 %; MJ: 58 %). The need for intubation was also similar (IF: 26 %; MJ: 10 %).

Complications. Air leaks occurred in six preterm infants (IF: 4; MJ: 2). Severe abdominal distension occurred in 5% with both systems. Five infants had significant nasal lesions (IF: 1; MJ: 4).

Conclusions

The efficacy and safety of both systems was similar in the variables studied and no significant differences were found.

Key words:
Nasal CPAP
Apnea-bradycardia syndrome
Respiratory distress
Postextubation in preterm infants
Infant Flow
Medijet
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Copyright © 2003. Asociación Española de Pediatría
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