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ARTICLES:
Teresa Nowadzky, Alfonso Pantoja, and John R. Britton
Bubble Continuous Positive Airway Pressure, A Potentially Better Practice, Reduces the Use of Mechanical Ventilation Among Very Low Birth Weight Infants With Respiratory Distress Syndrome
Pediatrics 2009; 123: 1534-1540 [Abstract] [Full text] [PDF]
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[Read eLetters] Questionable Benefit of Bubble CPAP
Harold Perl   (14 July 2009)

Questionable Benefit of Bubble CPAP 14 July 2009
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Harold Perl,
Neonatologist
Hackensack University Medical Center

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Re: Questionable Benefit of Bubble CPAP

hperl{at}humed.com Harold Perl

The authors of this article should be commended for an excellent CQI project and their ability to change the culture of their unit regarding CPAP in a relatively short period of time. This is no easy feat. The title of this article,"Bubble Continuous Positive Airway Pressure, A Potentially Better Practice, Reduces the Use of Mechanical Ventilation Among Very Low Birth Weight Infants With Respiratory Distress Syndrome" and its stated conclusion suggests that BCPAP has a benefit over conventional CPAP(CCPAP) in reducing duration on mechanical ventilation. Unfortunately, the data presented in this article does not support this conclusion. Table 4: Respiratory Outcomes shows that the most significant difference was in "Mechanical ventilation only" with 12.8% in Grp 1 and only 0.8% in Grp 2(p<0.001). Clearly this does not represent a benefit of BCPAP over CCPAP because Grp 1 never received any CPAP.This difference is not an 'outcome' of BCPAP and should have been listed under Pt. Characteristics. It actually represents a change in the culture of the NICU during the timeframe of Grp2 when it became acceptable that almost everyone (99.2% of babies) should have at least some attempt of managment on CPAP. This change also accounts for the reduced number of days of conventional ventilation as well but in no way addresses the question of BCPAP vs. CCPAP.

Conflict of Interest:

None declared