From the Research
Introduction to CPAP Weaning Guidelines for Neonates
CPAP (Continuous Positive Airway Pressure) is a common treatment for respiratory distress syndrome in preterm infants. However, the strategies for weaning infants off CPAP are not well defined, and there is considerable variation in methods between institutions.
Weaning Methods
Several methods have been studied for weaning preterm infants from CPAP, including:
- Sudden weaning from CPAP to room air 1
- Gradual decrease of CPAP pressure 1, 2
- Graded-time off CPAP (cycling) 2
- Weaning to high or low flow nasal cannula 3, 4
- A combination of these methods 2
Key Findings
Studies have shown that gradual weaning of CPAP pressure is more successful than sudden weaning in the initial trial off CPAP 1. Heated humidified high-flow nasal cannula (HHHFNC) therapy has been used as a CPAP weaning method, but evidence to support its use is still controversial 3. Neurally adjusted ventilatory assist (NAVA) has been shown to be effective and safe in neonates, with the electrical activity of the diaphragm (EAdi) peak being a reliable index to guide weaning and extubation 5.
Treatment and Dosing
When weaning preterm infants from CPAP, the following treatment and dosing considerations should be taken into account:
- Gradual decrease of CPAP pressure by 1 cm H2O every 8 hours until 3 cm H2O is reached 1
- Reduction of flow rate by 1 liter/min every 24 hours to 2-3 liters/min depending on body weight when using HHHFNC 3
- Cyclic use of HFNC every 3 hours for 3 days when weaning from NCPAP 4
Differentials and Caveats
When weaning preterm infants from CPAP, it is essential to consider the following differentials and caveats:
- Preterm infants should be stable on a low CPAP pressure with no (or minimal) oxygen requirement before weaning 2
- Cycling off CPAP may increase the duration of CPAP and length of hospital stay without beneficial effect on success of weaning 2
- Nasal trauma is a potential complication of CPAP weaning, and HHHFNC may be associated with less nasal trauma compared to direct weaning from CPAP 3
Conclusion
In conclusion, the CPAP weaning guidelines for neonates are not well established, and further studies are needed to determine the best strategy for weaning. However, gradual weaning of CPAP pressure and the use of HHHFNC or NAVA may be effective and safe methods for weaning preterm infants from CPAP.