comparing hhhfnc and ncpap ventilation methods for the prevention of extubation failure in preterm infants

Conditions: Extubation Failure; Prematurity

Summary: purpose is to show that hhhfnc method is as effective and safe as ncpapand 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. 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 \ 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.

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 \ 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 \ 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.

Eligibility criteria:
inclusion criteria: preterm infants with gestational age between 26 weeks 0 days and 31 weeks 6 days will be included. - exclusion criteria: 1- presence of major congenital anomaly, 2- presence of neuromuscular disease, 3- need of surgery within 7 days following the extubation 4- consent not provided or refused -