Comparing Heated Humidified High-flow Nasal Cannula Therapy and Nasal Continuous Positive Airway Pressure (nCPAP) Ventilation Methods for the Prevention of Extubation Failure in Preterm Infants Less Than 32 Weeks' Gestational Age: Randomized Clinical Trial

Brief Summary

Detailed Description

Purpose is to show that HHHFNC method is as effective and safe as nCPAP and even more comfortable than it as non-invasive respiratory support for the prevention of extubation failure in preterm with gestational age of 26-32 weeks. Method Primary Outcome Measures: The effectiveness of HHHFNC and nCPAP techniques for the prevention of extubation failure within 7 days following the first extubation in preterms in need of mechanical ventilation within the first 7 postnatal days Secondary Outcome Measures: * the total duration of invasive and non-invasive respiratory support and the duration of free oxygen demand of patients * Premature morbidities such as PDA, NEC, ROP, IVH, BPDand sepsis * The degree of nasal trauma score and the degree of nasal mucosal injury * FiO2 levels first before extubation and 6 hours after extubation * The causes of reintubation such as apnea, acidosis, and increased need of FiO2 * The reintubation predisposing factors such as pneumothorax, atelectasis, PDA after extubation * The weight change in the first 7-day period after extubation * The two groups in terms of neurodevelopmental changes Study design Patients requiring mechanical ventilation for at least 6 hours on the first 7 postnatal days will be included in the study. When patients were Fi O2 \< 0,40, Pa CO2 \< 65 mmHg, pH\> 7.20, MAP (mean airway pressure) \<7 cm H2O, they will be extubated if statistically stable. Oxygen-air mixture of 4-6 l / min flow rate will be set in HHHFNC group, and pressure will be set to 5-8 cm H2O in NCPAP group. When flow is 2 l / min, FiO2 is\<0.30 at 24 hours and above, free oxygen will be introduced. In NCPAP group, when pressure is 5 cm H2O and FiO2 \< 0.30 at 24 hours and above, free oxygen will be introduced. Reintubation criteria is set as; * FiO2 of ≥ 0.50 in order to keep oxygen saturation measured by pulse oximetry above 90 % and higher, * Apnea requiring more than 6 alerts in a 24 -hour period in 6 consecutive hours or more than 1 apnea requiring positive pressure ventilation, * Persistent acidosis; presence of pH \< 7.20 and PCO2 \> 65 mmHg in two different blood gases drawn with an interval of at least 30 minutes or treatment-resistant metabolic acidosis, * Severe respiratory distress, * Pulmonary haemorrhage and cardiopulmonary arrest.

Primary Outcomes