Optimising bi-level non-invasive ventilation in preterm neonates: a systematic review
Bibliographic record
Abstract
Abstract Bi-level non-invasive ventilation (BiPAP) can be used as a step-up from continuous positive airway pressure (CPAP) in preterm neonates to reduce the amount of time spent mechanically ventilated. Prolonged mechanical ventilation is associated with increased morbidity and mortality. MEDLINE was searched using the terms CPAP and BiPAP. Four studies reported a significant reduction in the need for mechanical ventilation when applying BiPAP compared with CPAP. Two studies reported no significant benefit. Studies which used 15/5 cm H 2 O or 20/5 cm H 2 O were more successful than those that used 6/5 cm H 2 O or 8/5 cm H 2 O. There was no discernible pattern to the effectiveness of respiratory rate, synchronisation or inspiratory time. In conclusion, BiPAP should be delivered at 15-20/5 cm H 2 O or 20/5 cm H 2 O. Key messages BiPAP has greater efficacy than CPAP at reducing the need for mechanical ventilation in preterm neonates with respiratory distress An inspiratory pressure of at least 15 cm H 2 O should be employed wherever possible There is insufficient evidence to recommend any particular respiratory rate, inspiratory time or synchronisation mode over another Structured clinical question Is BiPAP (intervention) more effective than CPAP (control) at reducing the need for mechanical ventilation in preterm neonates, and if so, what are the most effective pressures, inspiratory time, respiratory rate and synchronization mode to use? Search strategy MEDLINE was searched via Pubmed using the terms ‘CPAP’ AND ‘BiPAP’. This yielded 223 results. Further references within these articles were considered. Studies were included if they compared the effect of BiPAP vs CPAP on the need for mechanical ventilation or tracheal intubation. A total of 18 relevant studies were identified, including 15 randomised controlled trials (RCT) and one meta-analysis. Eight studies were excluded because they were already reported in the meta-analysis. Two were excluded because they were retrospective. A further two were excluded due to a lack of statistical analysis in the reporting. [1, 2]. A total of six studies remained for consideration; see table.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.006 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".