Nasal High Frequency Oscillatory Ventilation Research Articles

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.

RESPIRATORY SUPPORT OF PRETERM INFANTS AFTER EXTUBATION: COMPARISON OF CLINICAL EFFICACY OF STANDART AND HIGH FREQUENCY NON-INVASIVE VENTILATION

In animal models nasal high frequency oscillatory ventilation appears to provide better development of immature lung causing less injury. This open randomized study compared the clinical efficacy of the standard (SV) and high frequency (HFV) non-invasive (nasal) ventilation after primary extubation of very preterm infants. The study included 24 very premature infants with birth weight ≤1500 gand respiratory distress syndrome. Before the first extubation infants were randomized into the main (n = 12) or control (n = 12) group. A certain mode of respiratory support was used according to the protocol for at least 72 hrs. The primary study outcome was the need for re-intubation within 72 hrs after the initial extubation. Mortality, incidences of bronchopulmonary dysplasia (BPD) and other important complications of prematurity were also compared in these groups. The frequency of re-intubation within the first 72 hrs. of non-invasive respiratory support was similar in both groups (41.67%). No differences were observed between the groups for the total duration of respiratory support as well. The incidence of BPD was twice higher in the group of infants who were treated using nasal HFV (main group) according to physiological definition, but this difference was not significant (2 cases (16.67%) compared to 1 case (8.33%) accordingly; p = 0.78). BPD incidences according to the clinical definition were similar in the both groups (5 cases - 41.67%). The use of high-frequency non-invasive ventilation after primary extubation of very preterm infants has no obvious clinical advantages over the extubation followed by standard non-invasive ventilation.

Laryngeal Muscle Activity during Nasal High-Frequency Oscillatory Ventilation in Nonsedated Newborn Lambs

Background: We have previously shown that nasal pressure support ventilation (nPSV) can lead to an active inspiratory laryngeal narrowing in lambs. This, in turn, can limit lung ventilation and divert air into the digestive system, with potentially deleterious consequences. On the other hand, nasal high-frequency oscillatory ventilation (nHFOV) is particularly attractive in newborns, especially since, unlike nPSV, it does not require synchronization with the patient's inspiratory efforts. Objectives: The main aim of the present study was to test the hypothesis that glottal constrictor muscle activity (EMG) does not develop during nHFOV. A secondary objective was to study laryngeal EMG during nHFOV-induced central apneas. Methods: Polysomnographic recordings were performed in 7 nonsedated lambs which were ventilated with increasing levels of nPSV and nHFOV at both 4 and 8 Hz, in random order. States of alertness, diaphragm and glottal muscle EMG, SpO₂, and respiratory movements were continuously recorded. Results: While phasic inspiratory glottal constrictor EMG appeared with increasing nPSV levels in 6 out of 7 lambs, it was never observed with nHFOV. In addition, nHFOV at 4 Hz dramatically inhibited central respiratory drive in 4/7 lambs, with 64-100% of recording time spent in central apnea in 3 lambs. No glottal constrictor EMG was observed during these central apneas. Conclusion: nHFOV does not induce glottal constrictor muscle EMG in nonsedated newborn lambs, in contrast to nPSV. This may be an additional advantage of nHFOV relative to nPSV.

PS-381 Nasal High Frequency Ventilation Is Not More Effective Than Noninvasive Ventilation To Prevent Extubation Failure In Very Preterm Infants

Background In animal models nasal high frequency oscillatory ventilation appears to provide better lung development and less injury that means it could be protective against repeated need of conventional ventilation. In a randomised study we compared the clinical efficacy of nasal high frequency oscillatory ventilation (nHFOV) and nasal intermittent positive pressure ventilation (NIPPV) in prevention of repeated intubation in preterm infants with very low birth weight. Methods 24 preterm infants with birth weight Results Extubation failure rate after primary extubation was the same in the both groups – 41.67%. There was no difference in total duration of respiratory support between the groups. BPD developed in 2 infants (16.67%) in the nHFOV group and in 1 infant (8.33%) in the control group (p > 0.05). Conclusions In this study nHFOV was not found to be more effective than NIPPV in prevention of primary extubation failure in preterm infants with very low birth weight.