Non-invasive high-frequency oscillatory ventilation in preterm infants after extubation: a randomized, controlled trial

Li, Yan; Wei, Qiufen; Zhao, Dan; Mo, Yan; Yao, Liping; Li, Lingxiao; Tan, W. Y.; Pan, Xinnian; Yao, Jiayan; Dai, Wei; Zhong, Dan-Ni

doi:10.1177/0300060520984915

Cited by 21 publications

(39 citation statements)

References 23 publications

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“…Literature has reported that NHFOV reduced the incidence of reintubation in infants with difficulties in extubation due to BPD or other conditions (10,11). Our trial also found a lower reintubation rate and a lower BPD rate in the NHFOV group (5). Research regarding the safety of NHFOV showed the risks of brain injury, NEC, ROP, and air leak did not increase in preterm infants who received NHFOV, which was compatible with the results of our trial (10, 12).…”

Section: Discussionsupporting

confidence: 71%

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The long-term outcomes of preterm infants receiving non-invasive high-frequency oscillatory ventilation

Mo²,

Yao³

et al. 2022

Front. Pediatr.

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ObjectiveTo investigate the clinical outcomes of preterm infants who received non-invasive high-frequency oscillatory ventilation following extubation in a neonatal intensive care unit.MethodsInfants born between 25 and 34 weeks of gestation with a birth weight of <1,500 g, who were admitted into the neonatal intensive care unit of Guangxi Maternal and Child Health Hospital, Nanning, Guangxi, China, requiring mechanical ventilation on admission were randomized to the non-invasive high-frequency ventilation group, nasal intermittent positive pressure ventilation group, or nasal continuous positive airway pressure group following extubation. Their respiratory and neurodevelopmental outcomes were assessed at 12 and 24 months of corrected age.ResultsAmong 149 preterm infants who underwent randomization, 139 completed their treatment in the neonatal intensive care unit (45, 47, 47 in the non-invasive high-frequency ventilation group, nasal intermittent positive pressure ventilation group, or nasal continuous positive airway pressure group, respectively), 113 were assessed at 12-month corrected age, and 110 of 113 were assessed again at 24-month corrected age. There were no differences in the number of times bronchitis, pneumonia, wheezing episodes, and re-hospitalization rates appeared due to respiratory diseases among the three groups (P > 0.05); the pulmonary function tests at 12-month corrected age showed respiratory rate, tidal volume, inspiratory time/expiratory time, time to peak expiratory flow/expiratory time, volume at peak expiratory flow/expiratory volume, expiratory flow at 25, 50, and 75% tidal volume were all similar among infants from the 3 groups (P > 0.05). There were no differences in the rates of neurodevelopmental impairment among the three groups at 24-month corrected age (P > 0.05).ConclusionAs post-extubation respiratory support in preterm infants, non-invasive high-frequency ventilation did not increase the rates of long-term respiratory morbidities and neurodevelopmental impairment compared with nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure.

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Section: Discussionsupporting

confidence: 71%

“…Research involving the influence of NHFOV on the risks of PVL or IVH is rare (19). In our trial, the incidence of severe IVH (grade III and above) is similar in the NHFOV group compared with the NIPPV group and the NCPAP group (5). When followed for 24-month CA, the neurodevelopmental outcomes remained reassuring in the NHFOV group.…”

Section: Discussionmentioning

confidence: 57%

The long-term outcomes of preterm infants receiving non-invasive high-frequency oscillatory ventilation

Mo²,

Yao³

et al. 2022

Front. Pediatr.

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“…We speculate that the effect of the oscillations may be counteracted by slightly smaller V T during nHFOV, ultimately leading to the same amount of CO 2 removal during the two modes of respiratory support. (4) In selected situations, for example, post-extubation or as primary respiratory support after birth, the small benefits detected in this study may be sufficient to explain the superiority of nHFOV seen in smaller clinical trials 35–38. Finally, we speculate that an increased aeration homogeneity may be associated with a reduced rate of lung injury after long-term use of nHFOV, as reported by a small preclinical study 39.…”

Section: Discussionsupporting

confidence: 55%

Lung volume distribution in preterm infants on non-invasive high-frequency ventilation

Gaertner

Waldmann

Davis

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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IntroductionNon-invasive high-frequency oscillatory ventilation (nHFOV) is an extension of nasal continuous positive airway pressure (nCPAP) support in neonates. We aimed to compare global and regional distribution of lung volumes during nHFOV versus nCPAP.MethodsIn 30 preterm infants enrolled in a randomised crossover trial comparing nHFOV with nCPAP, electrical impedance tomography data were recorded in prone position. For each mode of respiratory support, four episodes of artefact-free tidal ventilation, each comprising 30 consecutive breaths, were extracted. Tidal volumes (VT) in 36 horizontal slices, indicators of ventilation homogeneity and end-expiratory lung impedance (EELI) for the whole lung and for four horizontal regions of interest (non-gravity-dependent to gravity-dependent; EELINGD, EELImidNGD, EELImidGD, EELIGD) were compared between nHFOV and nCPAP. Aeration homogeneity ratio (AHR) was determined by dividing aeration in non-gravity-dependent parts of the lung through gravity-dependent regions.Main resultsOverall, 228 recordings were analysed. Relative VT was greater in all but the six most gravity-dependent lung slices during nCPAP (all p<0.05). Indicators of ventilation homogeneity were similar between nHFOV and nCPAP (all p>0.05). Aeration was increased during nHFOV (mean difference (95% CI)=0.4 (0.2 to 0.6) arbitrary units per kilogram (AU/kg), p=0.013), mainly due to an increase in non-gravity-dependent regions of the lung (∆EELINGD=6.9 (0.0 to 13.8) AU/kg, p=0.028; ∆EELImidNGD=6.8 (1.2 to 12.4) AU/kg, p=0.009). Aeration was more homogeneous during nHFOV compared with nCPAP (mean difference (95% CI) in AHR=0.01 (0.00 to 0.02), p=0.0014).ConclusionAlthough regional ventilation was similar between nHFOV and nCPAP, end-expiratory lung volume was higher and aeration homogeneity was slightly improved during nHFOV. The aeration difference was greatest in non-gravity dependent regions, possibly due to the oscillatory pressure waveform. The clinical importance of these findings is still unclear.

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“…Mean airway pressure was remain constant in ( nasal HFOV 5.72±0.17 vs. 5.71±0.26 NIPPV ) in two groups of our study, in contrast (10.9 ± 2.06) to other previous studies 22 .Our study did not show any major difference in the duration of non-invasive ventilation among preterm neonates, however oxygen supplementation was significantly low in nasal HFOV 35.7% than NIPPV 64.3% ,(p= .019).In contrast to NCPAP ,Malakianet al ,was shown contrast difference in duration of non-invasive ventilation in nasal HFOV (p=0.01) among 28 wk till 34 wk GA neonates, 23 whereas no difference in need of mechanical ventilation .Li Y et al stated that nasal HFOV was seen effective in decreasing non-invasive ventilation period, in preterm with GA <34 wk as an extubation respiratory support. 24 Zhu et al also studied the same GA 28WK-34wk as we did in our study ,for nasal HFOV and NCPAP as an initial respiratory support ,mechanical ventilation need was( p<0.01),hence period of non-invasive ventilation was not elicted. 10 It was seen in our study that oxygen supplementation was significantly decreased in nasal HFOV 35.7% than NIPPV 64.3%.…”

Section: Methodssupporting

confidence: 57%

Use of Non-Invasive Ventilation in Reducing Partial Pressure of Carbon Dioxide Level (PaCO2) in Neonates with Respiratory Distress Syndrome

Ali¹,

Mahmud²

2022

J. Bahria Uni. Med. Dent. Coll.

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Objective: It has been observed that non-invasive ventilation used in premature with Respiratory distress syndrome and notably decrease level of partial pressure of carbon-dioxide (PaCO2) level in blood. The primary goal of this study was to assess the effect of non-invasive ventilation in decreasing the level of partial pressure of carbon dioxide (PaCO2) level and supplementary oxygen need in premature neonates with RDS. Study Design and Settings: This randomized controlled trial was done in Jan 2021 till August 2021 at PNS SHIFA Karachi. Methodology: Neonates with gestational age (GA <34 wk) with RDS at birth were randomly assigned to nasal intermittent positive pressure ventilation (NIPPV) and nasal high frequency oscillatory ventilation (NHFOV) for respiratory support after giving surfactant .Twenty three preterm babies were included in each group .Level of partial pressure of carbon dioxide at 2hrs and 24hrs of non-invasive ventilation and supplementary oxygen need was evaluated. Results: Non-invasive ventilation was found to reduce the PaCO2 level (p= .01), NIPPV (43.06±13.74) vs. (33.63±19.99) in NHFOV at 2hrs and 24hrs NIPPV (19.89±7.18) vs. NHFOV (14.04±8.39).Value of pH was also significant in two groups with optimal mean airway pressure. Supplementary oxygen period were also reduced in NHFOV than NIPPV group (35.7% vs. 64.3%). Conclusion: NHFOV was a beneficial mode in maintaining level of pH, PaCO2 level and reducing need of supplementary oxygen in preterm babies with RDS

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Non-invasive high-frequency oscillatory ventilation in preterm infants after extubation: a randomized, controlled trial

Cited by 21 publications

References 23 publications

The long-term outcomes of preterm infants receiving non-invasive high-frequency oscillatory ventilation

The long-term outcomes of preterm infants receiving non-invasive high-frequency oscillatory ventilation

Lung volume distribution in preterm infants on non-invasive high-frequency ventilation

Use of Non-Invasive Ventilation in Reducing Partial Pressure of Carbon Dioxide Level (PaCO2) in Neonates with Respiratory Distress Syndrome

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