Nasal CPAP: An Evidence-Based Assessment
7.6 Conclusions and Future Directions
Clearly NCPAP is an important therapy for infants with many causes of respiratory distress.
Review of the Summary Tables of evidence cur- rently available indicates that NCPAP is advan- tageous when used early, especially with surfactant, and for successful extubation.
Pneumothorax appears to be more common with NCPAP, especially if surfactant is not used in a timely fashion or close attention is not paid to delivered pressure. Suffi cient studies have not yet been done to defi nitively recommend one device over another. Variable-fl ow NCPAP appears to decrease work of breathing and may be most useful in the smallest infants. Bubble NCPAP and bi-level NCPAP may improve gas exchange.
Importantly, practitioners should be aware of how NCPAP may help their patients as well as where evidence is lacking, know potential com- plications, differences among devices, and be always willing to revise their patient care prac- tices in the face of new data.
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