Nasal High Frequency Oscillatory Ventilation Research Articles

The effect of NHFOV on hemodynamics in mild and moderately preterm neonates: a randomized clinical trial.

The aim of this study is to study cardio-respiratory effects of nasal high-frequency oscillatory ventilation (NHFOV) vs. NCPAP as an initial mode of ventilation in moderate-late-preterm infants. A randomized controlled trial was conducted in NICU of Alexandria University Maternity Hospital (AUMH). One-hundred late-moderate-preterm infants were randomly assigned to either NHFOV-group (n = 50) or NCPAP-group (n = 50). For both groups, functional echocardiography was performed in the first 24h to detect hemodynamic changes and respiratory outcome was monitored throughout the hospital stay. The main outcomes were hemodynamic measurements and myocardial function using functional echocardiography of those infants along with the respiratory outcome and complications. Kaplan-Meier survival plot was used representing time course of NCPAP and NHFOV failure. Left ventricular output values were not significantly different in both groups with median 202ml/kg /min and IQR (176-275) in NCPAP-group and 226ml/kg/min with IQR (181-286) in NHFOV group. Nevertheless, ejection fraction and fractional shortening were significantly higher in NHFOV-group with P 0.001. The time to weaning, the time to reach 30%-FIO2, the need for invasive ventilation, oxygen support duration, and maximal-FIO2 were significantly more in NCAPAP group. Conclusion: NHFOV is an effective and promising tool of non-invasive-ventilation which can be used as a primary modality of respiratory support in preterm infants with variable forms of respiratory distress syndrome without causing detrimental effect on hemodynamics or significant respiratory complications. Trial registration: NCT05706428 (registered on January 21, 2023). What is Known: • NHFOV might be beneficial as a secondary mode of ventilation and might have an impact on hemodynamics. What is New: • NHFOV can be used as an initial mode of ventilation with CDP beyond the reported pressure limits of CPAP without causing neither CO2 retention nor adverse hemodynamic consequences.

Erratum: Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial.

Erratum: Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial.

Erratum: Reintubation Rate between Nasal High-Frequency Oscillatory Ventilation versus Synchronized Nasal Intermittent Positive Pressure Ventilation in Neonates: A Parallel Randomized Controlled Trial.

Erratum: Reintubation Rate between Nasal High-Frequency Oscillatory Ventilation versus Synchronized Nasal Intermittent Positive Pressure Ventilation in Neonates: A Parallel Randomized Controlled Trial.

Fluctuations in Oxygen Saturation during Synchronized Nasal Intermittent Positive Pressure Ventilation and Nasal High-Frequency Oscillatory Ventilation in Very Low Birth Weight Infants: A Randomized Crossover Trial

Background: Very low birth weight (VLBW) infants on noninvasive ventilation (NIV) experience frequent fluctuations in oxygen saturation (SpO₂) that are associated with an increased risk for mortality and severe morbidities. Methods: In this randomized crossover trial, VLBW infants (n = 22) born 22+3 to 28+0 weeks on NIV with supplemental oxygen were allocated on two consecutive days in random order to synchronized nasal intermittent positive pressure ventilation (sNIPPV) and nasal high-frequency oscillatory ventilation (nHFOV) for 8 h. nHFOV and sNIPPV were set to equivalent mean airway pressure and transcutaneous pCO₂. Primary outcome was the time spent within the SpO₂ target (88–95%). Results: During sNIPPV, VLBW infants spent significantly more time within the SpO₂ target (59.9%) than during nHFOV (54.6%). The proportion of time spent in hypoxemia (22.3% vs. 27.1%) and the mean fraction of supplemental oxygen (FiO₂) (29.4% vs. 32.8%) were significantly reduced during sNIPPV, while the respiratory rate (50.1 vs. 42.6) was significantly higher. Mean SpO₂, SpO₂ above the target, number of prolonged (>1 min) and severe (SpO₂ <80%) hypoxemic episodes, parameters of cerebral tissue oxygenation using NIRS, number of FiO₂ adjustments, heart rate, number of bradycardias, abdominal distension and transcutaneous pCO₂ did not differ between both interventions. Conclusions: In VLBW infants with frequent fluctuations in SpO₂, sNIPPV is more efficient than nHFOV to retain the SpO₂ target and to reduce FiO₂ exposure. These results demand more detailed investigations into cumulative oxygen toxicities during different modes of NIV over the weaning period, particularly with regard to consequences for long-term outcomes.

Nasal High-Frequency Oscillatory Ventilation versus Nasal Intermittent Positive Pressure Ventilation In Pre-terms With Respiratory Distress Syndrome During Early Neonatal Period: A Randomized Controlled Trial

Objective: To determine the effectiveness of NHFOV versus NIPPV in reducing the need for invasive mechanical ventilation in preterm neonates with RDS (moderate-severe) during the first seven days of the life of neonate.&#x0D; Study Design: Randomized controlled study (ACTRN: 12622000291785).&#x0D; Place and Duration of Study: Neonatal Unit, PNS Shifa Hospital, Karachi Pakistan, from Jan to Aug 2021.&#x0D; Methodology: Forty-eight preterm neonates, with the gestational age of 27 weeks to 34 weeks with Respiratory distress Syndrome, were randomized to NHFOV Group (n=24) and NIPPV Group (n=24). The primary outcome was the need for invasive mechanical ventilation (IMV). The secondary outcomes were the duration of hospitalization, non-invasive respiratory support, mortality, abdominal distention, pneumothorax, need for surgery for patent ductus arteriosus, spontaneous intestinal perforation, and necrotizing enterocolitis, intraventricular haemorrhage≥ Grade-3, bronchopulmonary dysplasia, retinopathy of prematurity Stage-3.&#x0D; Results: There was no significant difference between NHFOV (64.7%) versus NIPPV (35.3%) groups in need of Invasive Mechanical Ventilation (p=0.13). Secondary outcomes were not significant between the two groups, air leak (p=0.31),necrotising enterocolitis (p=1.00), broncho-pulmonary dysplasia (p=0.31), retinopathy of prematurity (p=0.15).There was no intraventricular haemorrhage found between the two groups.&#x0D; Conclusion: Nasal high-frequency oscillatory ventilation was less statistically significant than NIPPV in reducing the need for invasive mechanical ventilation in the initial seven days of life in neonates with Respiratory distress syndrome.

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

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 &lt;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

Comparison of Two Noninvasive Ventilation Strategies (NHFOV Versus NIPPV) as Initial Postextubation Respiratory Support in High-Risk Infants After Congenital Heart Surgery

This study aimed to compare the effects of nasal high-frequency oscillatory ventilation (NHFOV) and noninvasive positive-pressure ventilation (NIPPV) as the initial postextubation therapies on preventing extubation failure (EF) in high-risk infants younger than three months after congenital heart surgery (CHS). This was a single-center, randomized, unblinded clinical trial. The study was performed in a teaching hospital. Between January 2020 and January 2021, a total of 150 infants underwent CHS in the authors' hospital. Infants younger than three months with a high risk for extubation failure who were ready for extubation were randomized to either an NHFOV therapy group or an NIPPV therapy group, and received the corresponding noninvasive mechanical ventilation to prevent EF. Primary outcomes were reintubation, long-term noninvasive ventilation (NIV) support (more than 72 hours), and the time in NIV therapy. The secondary outcomes were adverse events, including mild-moderate hypercapnia, severe hypercapnia, severe hypoxemia, treatment intolerance, signs of discomfort, unbearable dyspnea, inability to clear secretions, emesis, and aspiration. Of 92 infants, 45 received NHFOV therapy, and 47 received NIPPV therapy after extubation. There were no significant differences between the NHFOV and the NIPPV therapy groups in the incidences of reintubation, long-term NIV support, and total time under NIV therapy. No significant difference was found of the severe hypercapnia between the two groups, but NHFOV treatment significantly decreased the rate of mild-moderate hypercapnia (p < 0.05). Other outcomes were similar in the two groups. Among infants younger than three months after CHS who had undergone extubation, NIPPV therapy and NHFOV therapy were the equivalent NIV strategies for preventing extubation failure, and NHFOV therapy was more effective in avoiding mild-moderate hypercapnia.

Nasal High-Frequency Oscillatory Ventilation vs. Nasal Continuous Positive Airway Pressure as Therapy for Postextubation Respiratory Failure in Infants After Congenital Heart Surgery.

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).

Comparison Between Nasal High-Frequency Oscillatory Ventilation And Nasal Continuous Positive Airway Pressure In The Management Of Respiratory Distress Syndrome

Context: A neonatal respiratory distress syndrome occurs at or soon after delivery (<24 hours). Premature newborns with respiratory distress syndrome (RDS) often need breathing assistance. There has been a tendency to reduce in the previous decade the use of non-invasive ventilation modes (NIV) in neonatal intensive care units to prevent ventilator-induced lung damage, in particular after recent data showing NIV in preterm babies has equivalent efficiency compared to EMV. In practical practise, different forms of NIV may be employed include nasal continuing positive airway pressure and noninvasive intermittent positive airway pressure. Nasal continuous positive airway pressure is one of the most often utilised non-invasive techniques (NCPAP). Although HFV has been used in several neonatal critical care units, a relatively novel modality of nasal high frequency oscillatory ventilation (nHFOV) is limited in evidence of its utility. The objective of this research has been to examine the effectiveness and safety of nasal oscillatory ventilation with nasal airway continuous pressure in preterm baby respiratory distress syndrome therapy. Methods: This research is a (60 instances) clinical experiment conducted with respiratory distress syndrome (admitted to the Benha University Hospital Neonatal Intensive Care Unit and Benha Kids Hospital) between the 1–28 day age range. Cases were randomly picked in two groups: Group I: 30 instances of high-frequency oscillatory nasal ventilation were treated (nHFOV). Group II: 30 individuals with constant nasal airway pressure were treated (NCPAP). Methods: Detailed history of medicine. Total usage time NHFV and NCPAP usage time and oxygenation time required for each instance. Complication detection occurs during non-invasive breathing (pulmonary air leak syndrome, IVH, nasal injury and other.) Studies of imagery. Outcomes: There was no statistically significant difference in demographic data between the two groups. There was a statistically significant difference in IVH complication between Group I and Group II. The percentage of nasal septal injuries in Group I was significantly lower than in Group II. The rate of intervention failure (intubing and ventilator demand) in Group I was significantly lower than in Group II (3.3 percent, (26.6 percent) p value=0.030. Conclusion: High frequency nasal ventilation has a greater impact than continuous airway pressure on infants and is less complicated. This research revealed that the length of non-invasive respiratory support was greatly shortened by high frequency nasal ventilation and the necessity for intubation was minimised compared to the continuous positive airway pressure of RDS infants.

Nasal high-frequency oscillatory ventilation versus nasal continuous positive airway pressure as primary respiratory support strategies for respiratory distress syndrome in preterm infants: a systematic review and meta-analysis.

Nasal high-frequency oscillatory ventilation (NHFOV) is a new respiratory support strategy despite lacking of enough evidence in preterm infants with respiratory distress syndrome (RDS). The aim of the present systematic review was to explore whether NHFOV reduced the intubation rate as compared with nasal continuous positive airway pressure (NCPAP) as the primary respiratory support strategies in preterm infants with RDS. Medline, the Cochrane library, the Cochrane Controlled Trials Register, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data Information Site were searched from inception to Jan 1, 2021(Prospero2019 CRD42019129316, date and name of registration: Apr 23,2019, The clinical effectiveness of NHFOV vs NCPAP for preterm babies with respiratory distress syndrome). Pooled data from clinically randomized controlled trials (RCTs) comparing NHFOV with NCPAP as the primary respiratory supporting strategies in preterm infants with RDS were performed using the fixed-effects models whenever no heterogeneity was shown. The primary outcome was intubation rate. Four randomized controlled trials involving 570 participants were included. Comparing with NCPAP, NHFOV resulted in less intubation (relative risk (RR) 0.44; 95% confidence interval (CI) 0.29-0.67, P = 0.0002), and heterogeneity was not found among the trials in the fixed-effects model (P = 0.78, I2 = 0%). Similar result also appeared in sensitivity analysis after excluding one study with significant difference (RR 0.44; 95% CI 0.25-0.78, P = 0.005) (P = 0.58, I2 = 0%).Conclusion: NHFOV decreased the intubation rate as compared with NCPAP as primary respiratory supporting strategies in preterm infants suffering from RDS. Future research should assess whether NHFOV can reduce the incidence of bronchopulmonary dysplasia (BPD) and intubation rate in preterm infants with BPD. Fund by Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX0197), and "guan'ai" preterm Study Program of Renze Foundation of Beijing(K022). What is Known: • Nasal high-frequency oscillatory ventilation (NHFOV) has been described to be another advanced version of nasal continuous positive airway pressure (NCPAP). However, its beneficial effects among different studies as the primary modes in the early life of preterm infants with respiratory distress syndrome (RDS) were inconsistent. What is New: • Comparing with NCPAP, NHFOV decreases the risk of intubation as a primary respiratory supporting strategy in early life for preterm infants suffering from RDS.

Nasal High-Frequency Oscillatory Ventilation in Preterm Infants with Moderate Respiratory Distress Syndrome: A Multicenter Randomized Clinical Trial

Objective: To determine whether nasal high-frequency oscillatory ventilation (NHFOV) as a primary mode of respiratory support as compared with nasal continuous airway pressure (NCPAP) will reduce the need for invasive mechanical ventilation in preterm infants (26^0/7–33^6/7 weeks of gestational age [GA]) with respiratory distress syndrome (RDS). Methods: This multicenter randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a GA of 26^0/7–33^6/7 weeks with a diagnosis of RDS were randomly assigned to either the NCPAP (n = 150) or the NHFOV (n = 152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. Results: Treatment failure occurred in 15 of 152 infants (9.9%) in the ­NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (95% CI of risk difference: −15.2 to 0.4, p = 0.06). In the subgroup analysis, NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26^+0/7–29^+6/7weeks of GA (11.9 vs. 32.4%, 95% CI of risk difference: −39.3 to −1.7, p = 0.03) and birth weight <1,500 g (10.4 vs. 29.6%, 95% CI of risk difference: −33.8 to −4.6, p = 0.01). The rate of thick secretions causing an airway obstruction was higher in the NHFOV group than in the NCPAP group (13.8 vs. 5.3%, 95% CI of risk difference: 1.9–15.1, p = 0.01). No significant differences in other secondary outcomes were found between the NHFOV and NCPAP groups. Conclusions: NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26^+0/7 and 33^+6/7 weeks of GA. In the subgroup analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants <30 weeks of GA.

Non-invasive ventilation provides adequate gas exchange minimizing pulmonary and extrapulmonary complications

The objective : to evaluate the effectiveness of NIPPV (nasal intermittent positive pressure ventilation) and NHFOV (nasal hig h-f requency oscillatory ventilation) modes in newborns in the delivery room depending on the gestation period. Subjects and methods. A prospective randomized study included 88 premature newborns with the body mass of 1,405 (1,085–1,760) gr. and gestation period 31 (29–32) weeks. In children of the first group, the NIPPV mode was used, and in the second group – NHFOV . Children of each group were divided into subgroups: subgroup 1 consisted of newborns with a gestation period of 30–32 weeks, subgroup 2 – 26–29 weeks. Results. The need for the traditional ventilator was significantly greater in the group of NIPPV – 15 children, compared to the group of NHFOV – 2 children ( p = 0.001). In the same subgroup, statistically significant differences were found in the frequency of bronchopulmonary dysplasia ( BPD ) and intraventricular hemorrhage ( IVH ) ( p &lt; 0.05). In particular, in the NIPPV group, BPD was registered in 33.3% of cases, while in the NHFOV group – 3.7% ( p = 0.001). In children a gestation period of 26–29 weeks, the opposite results were noted. Retinopathy of prematurity was detected in 80% (12) of children on NHFOV and 12.5% (2) who received NIPPV ( p = 0,001)). There were also statistically significant differences in the frequency of BPD formation – 9 cases in the first group, 13 cases in the second group ( p = 0.04). Conclusion . The use of NIPPV as a starting method of respiratory support is indicated to newborns with the gestation age of 26–29 weeks, and while in newborns with the gestation period of 30–32 weeks, the use of NHFOV is highly effective.

Nasal High Frequency Oscillatory Ventilation Versus Nasal Continuous Positive Airway Pressure in Preterm Infants Less than 34 Weeks Gestation: A Multicentre Randomized Clinical Trial

Background: Nasal high-frequency oscillatory ventilation (NHFOV) has been increasingly applied as a rescue respiratory support after failure of nasal continuous positive airway pressure (NCPAP) in preterm infants. However, the efficacy of NHFOV as the primary mode of respiratory support for preterm infants with respiratory distress syndrome (RDS) has not been proved. Methods: This multi-center randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a gestational age of 260/7 to 336/7 weeks with a diagnosis of RDS was randomly assigned to either the NCPAP (n=150) or the NHFOV(n=152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. Results: Treatment failure occurred in 15 of 152 infants (9.9%) in the NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (P = 0.06). NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26+0/7 to 29+6 /7 weeks GA (11.9% vs 32.4%, P = 0.03) and BW<1500g (10.4% vs 29.6%, P = 0.01). Conclusions: NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26+0/7 and 33+6/7 weeks GA. In a secondary analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants <30 weeks gestational age. Trial Registration: The trial was registered with ClinicalTrials.Gov(NCT03099694) Funding Statement: The trial was initiated and planned by the researchers and funded by Scientific Research Projects unit of Chongqing (Project- cstc2016shms-ztzx13001) Declaration of Interests: None of the authors have declared conflicts of interests to participate in this trial. Ethics Approval Statement: The trial was approved by the ethics committee of Daping Hospital and the Research Institute of Surgery of the Third Military Medical University and the institutional review boards of each of the participating centers.

Noninvasive High-Frequency Oscillatory Ventilation: A Retrospective Chart Review.

This study aimed to review the feasibility of nasal high-frequency oscillatory ventilation (NHFOV) in preventing reintubation in preterm infants. This is a retrospective cohort study of all premature newborn infants placed on NHFOV in a single-center neonatal intensive care unit. Twenty-seven patients (birth weight: 765 ± 186 g, gestational age: 28 ± 2 weeks) were commenced on NHFOV on 32 occasions. NHFOV was used immediately postextubation as the primary mode of noninvasive ventilation (NIV; prophylaxis) in 10 of 32 occasions and as "rescue" (failure of NCPAP or biphasic CPAP) in 22 of 32 occasions. Treatment with NHFOV was successful in 22 occasions (69%) while on 10 occasions (31%) reintubation was required within 72 hours. In the rescue group, there was significant reduction in the mean (standard deviation [SD]) number of apneas (0.9 ± 1.07 vs. 0.3 ± 0.29, p < 0.005), but there were no significant changes in the PCO2 level (52 [ ± 9.8] vs. 52 [ ± 8.6] mm Hg, p = 0.8), or the FiO2 requirement (0.39 ± 0.19 vs. 0.33 ± 0.10, p = 0.055) before and after commencing NHFOV, respectively. The use of NHFOV is feasible as a prophylactic or rescue mode of NIV following extubation and was associated with decrease in the number of apneas without significant changes in PCO2 or oxygen requirements. A well-designed randomized control trial is needed to determine the indications, clinical outcomes, and safety of this treatment modality. · NHFOV is a new and evolving mode of noninvasive ventilation.. · The use of NHFOV is feasible as a prophylactic or rescue mode of noninvasive ventilation.. · A well-designed randomized control is needed to evaluate the efficacy and safety of NHFOV safe..

Nasal High Frequency Oscillatory Ventilation for Respiratory Failure due to Respiratory Syncytial Virus Bronchiolitis: Case Report

The authors describe a case of acute respiratory failure due to severe bronchiolitis. During high-flow nasal cannula ventilation, the blood's high levels of hypercapnia had taken them to plan the sedation and the orotracheal intubation. However, before attempting intubation, a nasal high frequency oscillatory ventilation cycle was performed and it led to a marked improvement in the blood gas, avoiding in this way the invasive ventilation.

Nasal High Frequency Oscillatory Ventilation (nHFOV): Rescue Treatment for Respiratory Distress Syndrome in Preterm Infants.

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Nasal High-Frequency Oscillatory Ventilation in Preterm Infants With Respiratory Distress Syndrome and ARDS After Extubation: A Randomized Controlled Trial

Nasal high-frequency oscillatory ventilation (NHFOV) has been described as supplying the combined advantages of nasal CPAP (NCPAP) and HFOV. However, its effect on preterm infants needs to be further elucidated. Our objective was to assess whether NHFOV could reduce intubation and Pco2 levels as compared with NCPAP during the postextubation phase in preterm infants. This was a single-center, randomized, controlled trial, and it was registered at clinicaltrials.gov (NCT03140891) and conducted between May 2017 and May 2018. Ventilated infants born at less than 37weeks' gestational age and ready to be extubated were included and randomized to either the NHFOV or NCPAP group. Primary outcomes were the incidence of reintubation within 1week and the Pco2 level within 6 h. A total of 206 preterm infants were included. Of them, 127 (61.7%) were diagnosed with respiratory distress syndrome, 53 (25.7%) with ARDS, and 26 (12.6%) with both respiratory distress syndrome and ARDS. Comparing with NCPAP, NHFOV significantly reduced the reintubation rate (16:87 vs35:68; 95%CI, 0.18-0.70; P= .002), especially in the subgroup with a gestational age of≤ 32weeks (12:34 vs25:20; 95%CI, 0.12-0.68; P= .004). The Pco2 level was also significant lower in the NHFOV group (49.6 ± 8.7 vs56.9 ± 9.9; 95%CI, -9.95 to -4.80; P= < .001). Moreover, NHFOV significantly reduced the reintubation rate in preterm infants with ARDS (10:33 vs 21:15; 95% CI, 0.08-0.57; P = .002). NHFOV was shown to be superior to NCPAP in avoiding reintubation, especially in very preterm infants and those infants diagnosed with ARDS. ClinicalTrials.gov; No.: NCT03140891; URL: www.clinicaltrials.gov.

Nasal high frequency oscillatory ventilation in newborn infants: A review of the literature

Nasal high frequency oscillatory ventilation in newborn infants: A review of the literature

Non-invasive Ventilation in Preterm Infants: A Clinical Review

Non-invasive ventilation (NIV) has gained increased popularity in the neonatal intensive care unit, because it is less likely to cause the short and long-term pulmonary complications associated with invasive mechanical ventilation. There are now number of NIV strategies available for the routine respiratory care of preterm infants including nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), nasal high frequency oscillatory ventilation (NHFO) and high flow nasal cannula (HFNC). These strategies are often used in combination with less invasive surfactant administration (LISA) and methylxanthines to augment respiratory drive. This review describes these various modes of NIV evaluating their impact on neonatal mortality and morbidity in preterm infants.

Leakage in nasal high-frequency oscillatory ventilation improves carbon dioxide clearance-A bench study.

Nasal high frequency oscillatory ventilation (nHFOV) is a promising mode of non-invasive neonatal respiratory support. To combine the effects of nasal continuous positive airway pressure (nCPAP) and high frequency oscillatory ventilation, an oscillatory pressure waveform is superposed to a nCPAP via a nasal or nasopharyngeal interface. nHFOV has been described to facilitate carbon dioxide (CO2 ) elimination compared to nCPAP. The influence of unintended leakage on CO2 elimination has not been investigated in nHFOV before. We explored the effects of oral leakage on CO2 elimination during nHFOV in a physical model of the neonatal respiratory system. A neonatal ventilator was connected to an airway- and lung model using binasal prongs as interface. The model comprised a continuous CO2 influx. Alveolar CO2 partial pressure was continuously measured. Gas flow rates and pressures were measured simultaneously at the prongs, pharynx, lung, and at the leakage. Effects of combined nasopharyngeal leakage (0, 5, or 10 L/min) on CO2 elimination, gas flow rate and pressure were determined at various ventilation frequencies (6, 8, 10, and 12 Hz) and amplitudes (10%, 20%, and 30% of maximum ventilator performance) at a mean airway pressure of 10 cmH2 O. nHFOV with moderate leakage was more effective in CO2 elimination than without leakage (P < 0.001) for all tested amplitudes and frequencies. Maximum leakage resulted in highly variable, partly ineffective CO2 elimination. A moderate oral leakage rather improves than impairs gas exchange during non-invasive ventilatory support with nHFOV. Pediatr Pulmonol. 2017;52:367-372. © 2016 Wiley Periodicals, Inc.