Abstract
Objective: This study aimed to evaluate the effects of nasal high-frequency oscillatory ventilation (NHFOV) vs. nasal continuous positive airway pressure (NCPAP) on postextubation respiratory failure (PRF) in infants after congenital heart surgery (CHS).Method: Eighty infants underwent postoperative invasive mechanical ventilation for more than 12 h and planned extubation. The infants were randomized to undergo either NHFOV or NCPAP after extubation. Primary outcomes were the incidence of PRF and reintubation, the average PaCO2 level, the average oxygenation index (OI), and pulmonary recruitment in the early extubation phase. Secondary outcomes included the NCPAP/NHFOV time, length of hospital stay, treatment intolerance, signs of discomfort, pneumothorax, adverse hemodynamic effects, nasal trauma, and mortality.Results: Except for PaCO2 within 12 after extubation (39.3 ± 5.8 vs. 43.6 ± 7.3 mmHg, p = 0.05), there was no statistically significant difference for any of the primary outcome measure (PRF, reintubation within 12 h after extubation, oxygenation index within 12 h after extubation, or lung volumes on X-ray after extubation) or secondary outcome measures (duration of non-invasive ventilation, duration of hospital stay, ventilation intolerance, signs of discomfort, pneumothorax, nasal trauma, adverse hemodynamic effects, or death prior to discharge), p > 0.1 for each comparison.Conclusion: NHFOV therapy after extubation in infants after CHS was more efficient in improving CO2 cleaning than NCPAP therapy, but there was no difference in other outcomes (PRF, reintubation, oxygenation index, and pulmonary recruitment).
Highlights
In infants who undergo congenital heart surgery (CHS), cardiopulmonary bypass, acute cardiogenic pulmonary edema, and pulmonary infection may contribute to an increased risk of postextubation respiratory failure (PRF) [1]
All infants were supported with Nasal continuous positive airway pressure (NCPAP) or nasal high-frequency oscillatory ventilation (NHFOV) through silicone binasal prongs. If they met the criteria for reintubation, NCPAP or NHFOV treatment was stopped, and reintubation was encouraged. If they met the criteria for stopping Non-invasive ventilation (NIV) treatment, they would transfer from NCPAP or NHFOV therapy to conventional oxygen therapy
There were no significant differences in the main clinical characteristics, including sex, age, weight, surgical time, cardiopulmonary bypass (CPB) time, invasive mechanical ventilation (IMV) time, final PaCO2 levels, final oxygenation index (OI) levels and lung volumes before extubation, and types of congenital heart
Summary
This study aimed to evaluate the effects of nasal high-frequency oscillatory ventilation (NHFOV) vs. nasal continuous positive airway pressure (NCPAP) on postextubation respiratory failure (PRF) in infants after congenital heart surgery (CHS). Method: Eighty infants underwent postoperative invasive mechanical ventilation for more than 12 h and planned extubation. The infants were randomized to undergo either NHFOV or NCPAP after extubation. Primary outcomes were the incidence of PRF and reintubation, the average PaCO2 level, the average oxygenation index (OI), and pulmonary recruitment in the early extubation phase. Secondary outcomes included the NCPAP/NHFOV time, length of hospital stay, treatment intolerance, signs of discomfort, pneumothorax, adverse hemodynamic effects, nasal trauma, and mortality
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have