Comparison of Endotracheal Reintubation between Nasal High-Frequency Oscillation and Continuous Positive Airway Pressure in Neonates

Abstract

Objective This study aimed to compare the endotracheal reintubation between nasal high-frequency oscillation (nHFO) and nasal continuous positive airway pressure (nCPAP) with face mask groups who were followed up for up to 7 days. Study Design We performed a retrospective cohort study of extubated neonates admitted between 2013 and 2017. We used a Cox's proportional hazards model to adjust for significant between-group differences in baseline characteristics. Results One hundred and ninety-nine neonates were on either nHFO or nCPAP after extubation. The median (interquartile range) gestational age and birth weight were 31 (29, 33) weeks and 1,450 (1,065, 1,908) grams, respectively. From the univariate analysis, gestational age, ventilator modes, mean airway pressure, fraction of inspired oxygen, oxygen index, caffeine therapy, and initial continuous positive airway pressure level were significantly different between the nHFO and nCPAP groups. There was no significant difference in the 7-day reintubation rate of neonates on nHFO compared with nCPAP (hazard ratio: 2.39; 95% confidence interval: 0.97–5.84; p = 0.05). By multivariate analysis, there was no statistically significant difference of reintubation rate between nHFO and nCPAP by Cox's proportional hazards model. Conclusion The nHFO mode with face mask is the choice for noninvasive ventilation to prevent reintubation during the week following extubation.

Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia

“…-sentence seems to need some fixing up …], Multifaceted interventions for infection prevention and control and a VAP prevention care bundle must be implemented[you don't 'implement' a care bundle, maybe 'used' or 'pre-prepared and available' or something ] to reduce neonatal VAP. 21,28,29 reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.…”

Nasal high-frequency oscillatory ventilation versus nasal continuous positive airway pressure as primary respiratory support strategies for respiratory distress syndrome in preterm infants: a systematic review and meta-analysis

“…(table 2) To further verify the results, a summary of all clinical studies referring to NHFOV in newborn infants was made and it was shown in table 4. [35][36][37][38] According to the summary, four reasons were accessible. Firstly, according to the report of Mukerji et al, [39] visible chest oscillation was not necessary because of elimination of CO 2 during NHFOV also occurring in the upper respiratory airway deadspace; Secondly, the mean tidal volume was higher with I:E at 50% than at 33% (2.4 ml vs. 1.4 ml; P < 0.001); [10] Thirdly, the setting of respiratory parameters should also be adjusted according to diagnosis and purpose, and an example was that Luca et al suggested different parameters boundaries for NHFOV use in BPD-risk and postextubation newborn infants.…”

Non-invasive Respiratory Support of the Premature Neonate: From Physics to Bench to Practice

“…Studies exploring how NIMV affects the development of BPD when compared to CPAP have shown conflicting results; these disparities are likely related to study design, timing of intervention, and inherent differences in interfaces and devices. How HFNV compares to NIMV is yet to be evaluated, but it appears to be superior to nCPAP in supporting premature infants with improved CO 2 clearance and reducing the need for intubation (106)(107)(108)(109).…”

“…Infants in the HFNV group were of lower gestational age and had higher oxygenation indices indicating worse clinical status at recruitment. Despite these differences, HFNV was shown to be as effective as nCPAP in preventing reintubation (108).…”