Nasal intermittent positive pressure ventilation vs free flow oxygen during neonatal intubation: A randomized control trial

Objectives: To compare change in oxygen saturation (SPO2) and other parameters during endotracheal intubation (ETI) in newborns on nasal intermittent positive pressure ventilation (NIPPV) versus free flow oxygen (FFO).
Method: In this randomized controlled trial, FFO at 10 L/min was delivered during ETI in FFO group and in NIPPV group, newborns received NIPPV during ETI. Procedure was video recorded.
Results: A total of 50 newborns was enrolled, 25 in each group. Reduction in mean SPO2 from baseline to during ETI (0.56 vs 4.4) in NIPPV vs FFO, p=0.009] and from baseline to after intubation (-0.32 vs 3.8) in NIPPV vs FFO, p=0.01] were significantly higher in FFO group compared to NIPPV group. Reduction in mean heart rate from baseline to during intubation (16.48 vs 17.16) for NIPPV vs FFO group (p=0.92)] and from baseline to post intubation (9.08 vs 13.56) for NIPPV vs FFO group (p=0.41) were non-significant. Successful first-attempt intubation (68% vs 60% in NIPPV vs FFO group, (p=0.556)], total intubations within 30 seconds (88.2% vs   80%) in NIPPV FFO group, (p=0.645)] and mean time for intubation (27.80 vs 32.28 seconds for NIPPV vs FFO group, p=0.306) were non-significant.
Conclusions: NIPPV prevented reduction in SPO2 in newborns during and after intubation compared to FFO.