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

Li, Yan; Mo, Yan; Yao, Liping; Wei, Qiufen; Meng, Danhua; Tan, W. Y.; Pan, Xinnian

doi:10.3389/fped.2022.865057

Cited by 10 publications

(5 citation statements)

References 17 publications

(11 reference statements)

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“…Five articles potentially satisfied the included criteria by reviewing the titles and abstracts. Finally, four eligible articles were included for further analysis, [16][17][18][19] and one article was excluded because the primary outcome was the rates of long-term respiratory morbidities and neurodevelopmental impairment in preterm infants 20 (Figure 1).…”

Section: Study Selectionmentioning

confidence: 99%

Noninvasive high‐frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation for preterm infants as an extubation support: A systematic review and meta‐analysis

Wang

Zhou

Gao

et al. 2022

Pediatric Pulmonology

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Objective We aimed to explore whether noninvasive high‐frequency oscillatory ventilation (NHFOV) could reduce the incidence of reintubation compared with nasal intermittent positive pressure ventilation (NIPPV) in the postextubation phase of preterm infants. Methods Randomized controlled trials of NHFOV versus NIPPV were searched in PubMed, EMBASE, Cochrane Central, and MEDLINE. Meta‐analysis was performed using Review Manager 5.3. Results Four randomized controlled trials including 1138 preterm infants were included in this study. Compared with NIPPV, NHFOV reduced the incidence of reintubation in the post‐extubation phase of preterm infants (p = 0.01, RR = 0.72, 95% confidence interval (CI): 0.56∼0.94), and no heterogeneity was found in the four studies (p = 0.55, I2 = 0%). In the sensitivity analysis, the result showed that there was no significant difference in the incidence of reintubation between NHFOV and NIPPV after excluding one study (p = 0. 05, RR = 0.76 95% CI: 0.58∼1.00), and no heterogeneity was found in the other three studies (p = 0.95, I2 = 0%). There was no statistical difference between NHFOV and NIPPV in BPD, air leak, IVH (≥Grade III) and mortality. Conclusion Among mechanically ventilated preterm infants, compared with NIPPV, NHFOV was potentially beneficial to reduce the incidence of reintubation after extubation and did not increase the risk of complications.

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Section: Study Selectionmentioning

confidence: 99%

Noninvasive high‐frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation for preterm infants as an extubation support: A systematic review and meta‐analysis

Wang

Zhou

Gao

et al. 2022

Pediatric Pulmonology

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“…A follow-up study aiming to explore the long-term safety of NHFOV demonstrated that preterm VLBW infants who received NHFOV after their first extubation at birth, compared with NIPPV or CPAP, did not differ significantly in the number of episodes of bronchitis, pneumonia, wheezing and re-admission rates at 24 months corrected age. In addition, pulmonary function tests and the incidence of neurodevelopmental impairment at 12 and 24 months corrected age were similar between the groups (41). The study, however, had a relatively small sample size (n = 139 infants) and low follow up rate (113 out of 139 infants at 12 months and 110 out of 139 infants at 24 months corrected age) and therefore further evidence is required.…”

Section: Nasal High-frequency Oscillatory Ventilation (Nhfov)mentioning

confidence: 89%

Neonatal respiratory support strategies—short and long-term respiratory outcomes

Kaltsogianni¹,

Dassios²,

Greenough³

2023

Front. Pediatr.

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Mechanical ventilation (MV), although life-saving, is associated with chronic respiratory morbidity in both preterm and term born infants. New ventilation modes have been developed with the aim of minimising lung injury. These include invasive and non-invasive respiratory support strategies, techniques for less invasive surfactant administration (LISA) and closed-loop automated oxygen control (CLAC) systems. Increasingly, newborn infants with signs of respiratory distress are stabilised on continuous positive airway pressure (CPAP) and receive LISA. Early CPAP when compared to mechanical ventilation reduced the incidence of BPD and respiratory morbidity at 18 to 22 months corrected age. Nasal intermittent positive pressure ventilation reduced treatment failure rates compared to CPAP, but not bronchopulmonary dysplasia (BPD). LISA compared with intubation and surfactant delivery reduced BPD, but there is no evidence from randomised trials regarding long-term respiratory and neurodevelopmental outcomes. Synchronisation of positive pressure inflations with the infant's respiratory efforts used with volume targeting should be applied for infants requiring intubation as this strategy reduces BPD. A large RCT with long term follow up data demonstrated that prophylactic high frequency oscillatory ventilation (HFOV) improved respiratory and functional outcomes at school age, but those effects were not maintained after puberty. CLAC systems appear promising, but their effect on long term clinical outcomes has not yet been explored in randomised trials. Further studies are required to determine the role of newer ventilation modes such as neurally adjusted ventilator assist (NAVA). All such respiratory support strategies should be tested in randomised controlled trials powered to assess long-term outcomes.

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“…There is also an urgent need for clear criteria to define nHFOV failure. As regards the information on the outcomes of the infants supported using nHFOV, up to now, there are few studies suggesting that similar to HFOV, there is no adverse effect on cerebral hemodynamics [68] and no adverse effects compared to NCPAP and NIPPV after extubation [69]. Indeed, we need more studies in this respect.…”

Section: Discussionmentioning

confidence: 99%

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units – Results of a Recent Survey

OGNEAN,

Bivoleanu,

Cucerea

et al. 2024

Preprint

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Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS). Multiple noninvasive respiratory support modes are currently available in Romania, but little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). We aimed to identify the usage extent and clinical application of nHFOV in Romania. A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. The questionnaire was addressed to the leaders of all level III Romanian NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU’s size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10-17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%), heated, humidified high flow nasal cannula (HHHFNC) (61.9%), and nHFOV (11/21 units; 52.4%); 5/11 units reported frequent nHFOV use (in 2 or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). 10/11 units reported setting a mean airway pressure (MAP) equal to the CPAP level plus 1-2 cmH2O on rescue nHFOV after CPAP failure. Both dedicated equipment (45.5%) and hybrid ventilators (63.6%) were used for nHFOV delivery, with face/nasal masks and short binasal prongs being the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV; none of the units mentioned pneumothorax as an adverse effect. Only 3 of the NICUs had a written protocol for nHFOV use. Initial, minimum, and maximum amplitude and initial and minimum MAP settings used were significantly higher with hybrid ventilators as compared to dedicated equipment (p<0.05). Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV. A need for training for nHFOV use was identified, and efforts are needed at the national level to develop courses and training sessions, including using simulation workshops, to offer more information on optimal nHFOV use in clinical practice.

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

Cited by 10 publications

References 17 publications

Noninvasive high‐frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation for preterm infants as an extubation support: A systematic review and meta‐analysis

Noninvasive high‐frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation for preterm infants as an extubation support: A systematic review and meta‐analysis

Neonatal respiratory support strategies—short and long-term respiratory outcomes

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units – Results of a Recent Survey

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