JOURNAL READING

Effect of Bubble and Ventilator-derived

Continuous Positive Airway Pressure on the
Management of Respiratory Distress Syndrome
in Premature Neonates
Pembimbing : dr. Indrayadi, SpA(K)
Nur Ilmi Sofiah – Puspa Anggraini
OUTLINE

TELAAH
ABSTRACT RESULTS
JURNAL

INTRODUCTION DISCUSSION PICO - VIA

METHODS CONCLUSION KESIMPULAN

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ABSTRACT
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ABSTRACT

BACKGROUND

▰ In this study, we aimed to compare ventilator-derived and

bubble continuous positive airway pressure (CPAP) in
neonates with respiratory distress syndrome admitted to
Neonatal Intensive Care Unit of Vali-e-Asr Hospital,
Birjand, Iran, in 2014.

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 ABSTRACT

Materials and Methods

▰ This cohort study was conducted among 68 patients assigned into two
groups. The neonates in group A (32 infants) were treated with bubble
CPAP and those in group B (36 infants) were treated with a ventilator-
derived CPAP.
▰ The protocol of treatment was applying CPAP with the positive end-
expiratory pressure (PEEP) of 5-6 cm H2O and fraction of inspired oxygen
(FiO2) equivalent to 30-40%, depending on the gestational age.

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 ABSTRACT

Materials and Methods

▰ In case of need for higher oxygen levels to maintain oxygen

saturation of arterial blood (SpO2) (90-95%), surfactant was
administered and additional PEEP was applied (up to 8 cm
H2O).
▰ Data analysis was performed using independent t-test and
Chi-squared in the SPSS software, version 18.
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 ABSTRACT

Results
▰ The duration of CPAP and oxygen therapy was 1.67±1.22 days and 3.57±2.67 days
in group A and 2.09±1.53 days (P=0.21) and 4.67±3.74 days (P=0.16) in group B,
respectively.
▰ There was a significant difference between the groups in terms of discharge weight
and surfactant dosage (P=0.042 and P=0.007, respectively).
▰ Moreover, although the length of stay in hospital in the ventilation group was
almost 4 days longer than the other group, there was no significant difference
between the groups in this regard.

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 ABSTRACT

Conclusion

▰ There was no significant difference between bubble CPAP and

ventilator-derived CPAP. Moreover, further studies with larger
sample size are recommended.

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INTRODUCTION
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 INTRODUCTION

Respiratory distress syndrome (RDS) or hyaline membrane disease

is the most prevalent respiratory disease in premature neonates
and the leading cause of death in this population.(1, 2)

▰ Among respiratory support methods, mechanical ventilation

and continuous positive airway pressure (CPAP) are said to be
helpful in reducing mortality and morbidity rates.(3)
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INTRODUCTION

Mechanical ventilation is invasive and associated with several

complications.(4)

▰ In addition, the early use of CPAP, even without the use of

surfactant, in infants with RDS can improve the prognosis.(7)

▰ The neonatal application of CPAP reduces extubation failure

and apnea rates in addition to providing an alternative to
intubation and ventilation in RDS.(3, 5, 6) 11
 INTRODUCTION

Various CPAP methods are available that are different from each
other in terms of effectiveness and medical expenses, two
commonly used of which include bubble CPAP and ventilator-
derived CPAP.(8)

The goal of any CPAP delivery device is to prevent atelectasis and

airway closure.(11)

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 INTRODUCTION

It is important for the healthcare system to evaluate these

methods in order to select the most effective and cost-efficient
one.

Therefore, this study was performed to compare two CPAP

methods in terms of their effectiveness in the treatment of infant
RDS.

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3
METHODS
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 SUBJECTS

• Newborns with RDS at NICU of Vali-e-Asr Hospital, in Birjand,

Iran in 2014.

• Newborns with RDS and a specific diagnosis determined by a

neonatologist.

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 SUBJECTS

• In this study, the inclusion criteria entailed:

• obtaining parental consent,
• having birth weight between 1000 and 2500 g,
• suffering from RDS with the symptoms of:
• cyanosis,
• tachypnea,
• nasal flaring, and
• retraction,
• as well as chest x-ray changes indicating a reticulogranular
pattern, air bronchogram, and reduced lung volume. 16
 STUDY DESIGN

In this cohort study,

•the duration of CPAP therapy,
•the amount of oxygen needed,
•the need for mechanical ventilation or surfactant injection,
•the presence of possible complications
were all considered as the measuring criteria for treatment
effectiveness.
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 STATISTICAL ANALYSIS

• Those criteria, as well as demographic data of the patients and

their parents, were collected and analyzed after treatment
follow-up.
• Data analysis was performed using Chi-squared and
independent samples t-test in SPSS software, version 18.
• In all the measurements, P-value less than 0.05 was
considered statistically significant.
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 TREATMENTS

GROUP B (36 patients)

GROUP A (32 patients)
•Nasal bubble CPAP with the constant
flow of gas of 6 L/min.
•PEEP of 5-6 cmH2O & FIO2 of 30-40%
•according to the standard method
developed by Pillow et al.(14)
•Nasal ventilator-derived CPAP with
the constant flow of gas of 6 L/min.
•PEEP of 5-6 cmH2O & FIO2 of 30-
40%
•according to the protocols of Yadav
et al. and Kugelman et al.(15, 16)

If higher oxygen levels were needed to maintain the SpO2 at the range of 90-95%,
surfactant was prescribed and CPAP increased up to 8 cm H2O.
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 TREATMENTS
GROUP B (36 patients)
GROUP A (32 patients)
•Nasal bubble CPAP with the constant •Nasal ventilator-derived CPAP with
the constant flow of gas of 6 L/min.
flow of gas of 6 L/min.
•PEEP of 5-6 cmH2O & FIO2 of 30-40% •PEEP of 5-6 cmH2O & FIO2 of 30-
40%
•according to the standard method
developed by Pillow et al.(14)
•according to the protocols of Yadav
et al. and Kugelman et al.(15, 16)
After receiving CPAP during the first 6 hours after birth,
surfactant was prescribed if PEEP >6 cmH2O and
FIO2 >30% (GA <26 weeks) and >40% (GA >26 weeks) 20
 TREATMENTS

If higher oxygen levels were needed

to maintain the SpO2 at the range of 90-95%,
surfactant was prescribed and CPAP increased up to 8 cm H2O.

If the patient receiving CPAP

could not maintain the SpO2 range beyond 90%,
synchronized intermittentmandatory ventilation was utilized.
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 ETHICAL CONSIDERATION

o Informed consent was obtained from all parents of patients.

o Approved by the Ethics Committee of the Birjand University
of Medical Sciences, Birjand, Iran.
o Registered under code No. IR.BUMS.REC.1394.441.

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RESULTS
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DISCUSSION
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CONCLUSION
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TELAAH JURNAL
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 TELAAH JURNAL

o Diakses dari Iranian Journal of Neonatology

o Secara garis besar, latar belakang jurnal ini cukup memenuhi komponen-
komponen yang seharusnya terdapat dalam latar belakang  pengenalan
singkat mengenai permasalahan yang diteliti pada penelitian dan tujuan
penelitian
o Hasil penelitian dalam jurnal ini telah memenuhi komponen-komponen
yang harus ada dalam jurnal  disajikan dalam bentuk deskripsi paragraf
dan tabel.

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PICO – VIA
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 V VALIDITY- Research questions

a. Is the research question well-defined that can be answered using

this study design?

Ya. Metode penelitian dengan studi kohort observasional prospektif

dapat menjawab tujuan dari penelitian ini.
V VALIDITY- Research questions

b. Does the author use appropriate methods to answer their

question?

Ya. Metode yang digunakan tepat untuk tujuan penelitian.

 V VALIDITY- Research questions

c. Is the data collected in accordance with the purpose of the

research?

Ya, data yang diambil sesuai dengan tujuan penelitian, yakni 68

neonatus dengan RDS yang dirawat di Neonatal Intesive Care Unit
(NICU) di Rumah Sakit Vali-e-Asr, Birjand, Iran selama tahun 2014.
V VALIDITY- Randomization

d. Was the randomization list concealed from patients, clinicians,

and researchers?

Tidak dilakukan randomisasi pada studi ini.

V VALIDITY- Interventions and co-interventions

e.Were the performed interventions described in sufficient detail to

be followed by others? Other than intervention, were the two groups
cared for in similar way of treatment?

Ya, intervensi dideskripsikan dengan cukup detail sehingga dapat

diikuti yang lain. Jumlah (aliran) oksigen, PEEP, dan FIO2 yang
diberikan kepada setiap grup diterangkan dengan rinci pada jurnal
ini.
 I IMPORTANCE

Is this study important?

Ya, penelitian ini penting untuk mengetahui perbandingan efektivitas

dua metode CPAP yakni bubble CPAP dan ventilator-derived CPAP
sebagai bagian terapi bayi dengan RDS. Hasil studi ini penting
terutama bagi sistem kesehatan, yaitu untuk membantu menilai dan
mengevaluasi metode-metode CPAP yang tersedia, serta untuk
membantu menentukan dan memilih metode CPAP yang lebih efektif
sebagai bagian terapi bagi bayi dengan RDS.
A APPLICABILITY

a.Are your patient so different from these studied that the

results may not apply to them?

Ya, Iran dan Indonesia merupakan 2 negara yang berbeda,

memiliki fasilitas kesehatan dan kultur masyarakat yang
berbeda. Namun, kriteria inklusi yang diharuskan dalam
penelitian ini dapat dipenuhi oleh masyarakat di Indonesia.
A APPLICABILITY

b. Is your environment so different from the one in the study

that the methods could not be use there?

Ya, secara sosiokultural, masyarakat Iran dan Indonesia

berbeda. Akan tetapi dua metode CPAP yang digunakan
dalam penelitian ini tersedia di Indonesia. Sehingga metode
yang digunakan dalam jurnal ini dapat diterapkan di
Indonesia.
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KESIMPULAN
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“Jurnal ini valid, penting, dan dapat diterapkan
sehingga jurnal ini dapat digunakan sebagai
referensi.”

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“ TERIMA
KASIH
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