Comparison of extubation success using noninvasive positive pressure ventilation (NIPPV) versus noninvasive neurally adjusted ventilatory assist (NI-NAVA)

Objective: Compare rates of initial extubation success in preterm infants extubated to NIPPV or NI-NAVA. Study design: In this pilot study, we randomized 30 mechanically ventilated preterm infants at the time of initial elective extubation to NI-NAVA or NIPPV in a 1:1 assignment. Primary study outcome was initial extubation success. Results: Rates of continuous extubation for 120 h were 92% in the NI-NAVA group and 69% in the NIPPV group (12/13 vs. 9/13, respectively, p= 0.14). Infants extubated to NI-NAVA remained extubated longer (median 18 vs. 4 days, p= 0.02) and experienced lower peak inspiratory pressures (PIP) than infants managed with NIPPV throughout the first 3 days after extubation. Survival analysis through 14 days post extubation showed a sustained difference in the primary study outcome until 12 days post extubation. Conclusions: Our study is the first to suggest that a strategy of extubating preterm infants to NI-NAVA may be more successful.