5: Non-Invasive High Frequency Ventilation versus bi-phasic CPAP in Infants <1250 Grams: A Pilot Randomized Controlled Trial

Abstract

The use of non-invasive ventilation (NIV) modalities has increased in recent years in an effort to minimize lung injury among preterm infants. Non-invasive high frequency oscillatory ventilation (NIHFOV) is a relatively new modality that is gaining popularity despite limited clinical data. To evaluate the effectiveness of NIHFOV versus bi-phasic continuous positive airway pressure (BP-CPAP) in preterm infants who fail therapy with CPAP. Infants with birth-weight <1250 grams being managed on CPAP were randomly assigned to NIHFOV or BP-CPAP if they were to meet pre-determined criteria for CPAP failure. Infants were eligible only after 72 h of age, and as long as they were <2,000 grams at time of randomization, irrespective of previous respiratory support. Strict protocols for adjustment of settings as well as criteria for failure were implemented for both study arms. Primary outcome was failure of assigned NIV mode; secondary outcomes included need for endotracheal mechanical ventilation (EMV) at 72 h and 7 days post-randomization and bronchopulmonary dysplasia (BPD). Thirty infants were randomized to NIHFV (n=14) or BP-CPAP (n=16). There was no difference in postmenstrual age [28.9 (2.0) vs. 28.9 (2.1) weeks, P=0.68], weight at time of randomization [920 (220) vs. 1000 (300) grams, P=0.73] or other baseline demographics between NIHFV vs. BP-CPAP groups. Failure of assigned NIV mode was not statistically different, although the trend favoured NIHFV [42.9% vs. 62.5%, P=0.28]. There was no difference in the rates of EMV at 72 h and 7 days post-randomization or BPD rates, as shown in Table 1. Non-invasive high frequency ventilation was not superior to BP-CPAP in this pilot study, despite a trend towards lower failure rates. Larger, appropriately powered studies are warranted to confirm or refute the present findings.