Early noninvasive high‐frequency oscillatory ventilation in the primary treatment of respiratory distress syndrome

Fischer, Hendrik; Rimensberger, Peter C.

doi:10.1002/ppul.23883

Cited by 9 publications

(5 citation statements)

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“…Most premature infants included in this meta-analysis had a gestational age of over 30 weeks. For preterm infants under 30 weeks of age, who are severely affected by RDS and face a high risk of BPD, nHFOV may be beneficial [40]. Other possible biases include: the use of different interfaces across the studies are known to impact on mechanical efficiency of all types of noninvasive ventilation and even for nHFOV [33]; the measure of pCO2 by different methods (arterial, arterialised capillary and transcutaneous) in different studies may affect the results.…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive high-frequency oscillatory ventilation as respiratory support in preterm infants: a meta-analysis of randomized controlled trials

Huang

et al. 2019

Respir Res

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BackgroundNoninvasive high-frequency oscillatory ventilation (nHFOV), a relatively new modality, is gaining popularity despite scarce evidence. This meta-analysis was designed to evaluate the efficacy and safety of nHFOV as respiratory support in premature infants.MethodsWe searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL from inception of the database to January 2019. All published randomized controlled trials (RCTs) evaluating the effect of nHFOV therapy with nasal continuous positive airway pressure (nCPAP) or biphasic nCPAP (BP-CPAP) in newborns for respiratory support were included. All meta-analyses were performed using Review Manager 5.3.ResultsA total of 8 RCTs involving 463 patients were included. The meta-analysis estimated a lower risk of intubation (relative risk = 0.50, 95% confidence interval of 0.36 to 0.70) and more effective clearance of carbon dioxide (weighted mean difference = − 4.61, 95% confidence interval of − 7.94 to − 1.28) in the nHFOV group than in the nCPAP/BP-CPAP group.ConclusionsOur meta-analysis of RCTs suggests that nHFOV, as respiratory support in preterm infants, significantly remove carbon dioxide and reduce the risk of intubation compared with nCPAP/BP-CPAP. The appropriate parameter settings for different types of noninvasive high-frequency ventilators, the effect of nHFOV in extremely preterm infants, and the long-term safety of nHFOV need to be assessed in large trials.

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Section: Discussionmentioning

confidence: 99%

“…Some studies may use venous CO2 and this should be avoided. In addition to sound design and adequate sample size, future research should not ignore populations of extremely premature infants, complex respiratory physiology and evaluating comfort [40, 41].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive high-frequency oscillatory ventilation as respiratory support in preterm infants: a meta-analysis of randomized controlled trials

Huang

et al. 2019

Respir Res

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“…The literature search identified 6,336 studies, 187 were selected for full-text review, and 14 underwent data extraction (36–50) ( Supplemental Fig. S1 , http://links.lww.com/PCC/C300).…”

Section: Resultsmentioning

confidence: 99%

Noninvasive Respiratory Support for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Carroll

Napolitano

Pons-Òdena

et al. 2023

Pediatric Critical Care Medicine

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To develop evidence-based recommendations for the Second Pediatric Acute Lung Injury Consensus Conference (PALICC) regarding the effectiveness of noninvasive respiratory support for pediatric acute respiratory distress syndrome (PARDS). These include consideration of the timing and duration of noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC), whether effectiveness varies by disease severity or by characteristics of treatment delivery, and best practices for the use of NIV.DATA SOURCES: MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost). STUDY SELECTION:Searches included all studies involving the use of NIV or HFNC in children with PARDS or hypoxemic respiratory failure.DATA EXTRACTION: Title/abstract review, full-text review, and data extraction using a standardized data extraction form. DATA SYNTHESIS:The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Out of 6,336 studies, we identified 187 for full-text review. Four clinical recommendations were generated, related to indications, timing and duration of NIV in patients with PARDS, predictors of NIV failure and need for intubation (signs and symptoms of worsening disease including pulse oximetry saturation/Fio 2 ratio), and use of NIV in resource-limited settings. Six good practice statements were generated related to how and where to deliver NIV, the importance of trained experienced staff and monitoring, types of NIV interfaces, the use of sedation, and the potential complications of this therapy. One research statement was generated related to indications of HFNC in patients with PARDS. CONCLUSIONS:NIV is a widely used modality for the treatment of respiratory failure in children and may be beneficial in a subset of patients with PARDS. However, there needs to be close monitoring for worsening disease and NIV failure.

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“…Finally, it should be mentioned that nHFOV may be beneficial in the primary treatment of respiratory distress syndrome [14], but a multicentre RCT of very preterm infants of 24 to 28 weeks’ GA would be necessary to investigate this in more detail [15]. NHFOV may also be an effective rescue treatment in infants with nCPAP failure, but again, a multicentric approach would be needed to investigate this hypothesis [16].…”

Section: Discussionmentioning

confidence: 99%

Hazards to avoid in future neonatal studies of nasal high-frequency oscillatory ventilation: lessons from an early terminated trial

2019

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Objective To investigate whether nasal high-frequency oscillatory ventilation (nHFOV) started immediately after extubation of mechanically ventilated very low birth weight infants reduces the partial pressure of carbon dioxide at 72 h after extubation in comparison with nasal continuous positive airway pressure. This randomised controlled single-centre trial aimed to include 68 preterm infants at high risk of extubation failure. Results Implementation of the study protocol was feasible. However, from 2015 to 2017, only six patients could be recruited, leading to early termination of the trial. The slow recruitment was due to the introduction of new strategies to avoid endotracheal mechanical ventilation, which reduced the number of eligible infants. Moreover, the included infants failed their extubation more often than anticipated, thereby increasing the required sample size. Based on our single-centre experience, we provide information for study planning and discuss the specific requirements for future trial protocols on nHFOV. The extubation of high-risk infants into nHFOV could well be beneficial, but a multicentric approach is necessary to investigate this hypothesis. Trial Registration Clinicaltrials.gov NCT02340299, on 16 January 2015 Electronic supplementary material The online version of this article (10.1186/s13104-019-4268-2) contains supplementary material, which is available to authorized users.

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Early noninvasive high‐frequency oscillatory ventilation in the primary treatment of respiratory distress syndrome

Cited by 9 publications

References 5 publications

Noninvasive high-frequency oscillatory ventilation as respiratory support in preterm infants: a meta-analysis of randomized controlled trials

Noninvasive high-frequency oscillatory ventilation as respiratory support in preterm infants: a meta-analysis of randomized controlled trials

Noninvasive Respiratory Support for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Hazards to avoid in future neonatal studies of nasal high-frequency oscillatory ventilation: lessons from an early terminated trial

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