An observational, prospective, multicenter study on rescue high-frequency oscillatory ventilation in neonates failing with conventional ventilation

Abstract

Background To achieve gas exchange goals and mitigate lung injury, infants who fail with conventional ventilation (CV) are generally switched to high-frequency oscillatory ventilation (HFOV). Although preferred in many neonatal intensive care units (NICUs), research on this type of rescue HFOV has not been reported recently. Methods An online registry database for a multicenter, prospective study was set to evaluate factors affecting the response of newborn infants to rescue HFOV treatment. The study population consisted of 372 infants with CV failure after at least 4 hours of treatment in 23 participating NICUs. Patients were grouped according to their final outcome as survived (Group S) or as died or received extracorporeal membrane oxygenation (ECMO) (Group D/E). Patients’ demographic characteristics and underlying diseases in addition to their ventilator settings, arterial blood gas (ABG) analysis results at 0, 1, 4, and 24 hours, type of device, ventilation duration, and complications were compared between groups. Results HFOV as rescue treatment was successful in 58.1% of patients. Demographic and treatment parameters were not different between groups, except that infants in Group D/E had lower birthweight (BW) (1655 ± 1091 vs. 1858 ± 1027 g, p = 0.006), a higher initial FiO 2 setting (83% vs. 72%, p < 0.001), and a higher rate of nitric oxide exposure (21.8% vs. 11.1%, p = 0.004) in comparison to infants who survived (Group S). The initial cut-offs for a successful response on ABG were defined as pH >7.065 (OR: 19.74, 95% CI 4.83–80.6, p < 0.001), HCO 3 >16.35 mmol/L (OR: 1.06, 95% CI 1.01–1.1, p = 0.006), and lactate level <3.75 mmol/L (OR: 1.09%95 CI 1.01–1.16, p = 0.006). Rescue HFOV duration was associated with retinopathy of prematurity ( p = 0.005) and moderate or severe chronic lung disease ( p < 0.001), but not with patent ductus arteriosus or intraventricular hemorrhage, in survivors ( p > 0.05). Conclusion Rescue HFOV as defined for this population was successful in more than half of the patients with CV failure. Although the response was not associated with gestational age, underlying disease, device used, or initial MV settings, it seemed to be more effective in patients with higher BW and those not requiring nitric oxide. Initial pH, HCO 3 , and lactate levels on ABG may be used as predictors of a response to rescue HFOV.

Mortality Risk Factors in Preterm Infants Treated with High-Frequency Jet Ventilation

“…A recent prospective observational multi-center study on rescue HFOV in neonates failing conventional ventilation reported that rescue HFOV was successful in improving gas exchange in 58% of subjects. 19 Although demographic and treatment characteristics at baseline were similar between groups, subjects who died had lower birthweight (1,655 6 1,091 vs 1,858 6 1,027 g, P ¼ .004), higher initial F IO 2 (0.83 vs 0.72, P < .001), and higher rate of exposure to inhaled nitric oxide (22% vs 11%, P ¼ .004) compared with survivors. Moreover, survivors demonstrated a mean reduction in oxygenation index after 1 h of HFOV, whereas nonsurvivors did not improve.…”

Therapeutic Effects and Outcomes of Rescue High-Frequency Oscillatory Ventilation for Premature Infants With Severe Refractory Respiratory Failure

“…Limited data about rescue use of HFOV in premature infants with severe respiratory failure can be found in the literature because it is di cult to de ne the "rescue" use of HFOV and conduct a randomized control trial [9,20,23,24]. Therefore, most studies have focused on comparisons between elective HFOV versus conventional ventilation [14][15][16]18].…”

“…Severe refractory respiratory failure was de ned when patients with a PaO 2 /FiO 2 ratio under 150 on two consecutive arterial blood gas (ABG) samples and/or had an initial oxygenation index (OI) ≥ 20 [21]. Poor response to conventional ventilation was de ned as failure to decrease PCO 2 > 10% and/or FiO 2 > 20% after 1 hour treatment by conventional ventilation (CV) at maximal settings [22,23]. Exclusion criteria were patients < 24 weeks of gestation, incomplete medical records, and patients with severe congenital anomalies (ex.…”

2019 Year in Review: Neonatal Respiratory Support

“…The Rescue-HFOV Trial Group prospectively evaluated factors affecting the response of 372 subjects who underwent rescue HFOV after failing conventional ventilation. 85 Subjects were separated into 2 groups: survivors and nonsurvivors or those who received extracorporeal membrane oxygenation (n ¼ 8). All subjects initially underwent volume-controlled ventilation with V T < 7 mL/kg and were managed with a permissive hypercapnia strategy to maintain a pH > 7.25.…”