Non-invasive Ventilation Mode Research Articles

629 Limits of airway pressure release ventilation (APRV) as a mode of non-invasive ventilation using the RAM Cannula

629 Limits of airway pressure release ventilation (APRV) as a mode of non-invasive ventilation using the RAM Cannula

A new tool to assess patient-ventilator synchrony in preterm infants receiving non-invasive ventilation: a randomized crossover pilot study.

Nasal synchronized intermittent positive pressure ventilation (nSIPPV) is an effective non-invasive ventilation technique, especially for preterm infants. Patient-ventilator synchrony is essential for providing effective respiratory support; however, no automated system is currently available for monitoring this parameter. A new tool for automatic assessment of patient-ventilator synchrony, the SyncNIV system, was developed and applied in this pilot study to evaluate differences between nSIPPV and non-synchronized nasal intermittent positive pressure ventilation (nIPPV) in preterm infants with respiratory distress. This study involved designing a custom algorithm for signal analysis. Data were collected through a polygraph that could simultaneously gather respiratory data from the patients and ventilator. Patient-ventilator synchrony was evaluated by applying the SyncNIV system in a randomized crossover study designed to compare nSIPPV and nIPPV. The primary outcome was the mean instant Synchrony Index (i-SI), defined as the portion of the inspiration effort sustained by ventilator inflation, expressed as a percentage. Fourteen infants with a median (IQR) gestational age of 28.6 (25.6-30.3), were enrolled. We analyzed 43,304 ventilator inflations and 50,221 patient breaths. The i-SI was 54.69% (44.49-60.09) in nSIPPV and 39.54% (33.40-48.75) in nIPPV, p<0.05. The SyncNIV system confirmed better i-SI during nSIPPV than during nIPPV, demonstrating its effectiveness in assessing the differences between these two modes of non-invasive ventilation in preterm infants. The SyncNIV system could be a useful tool for optimizing the ventilation parameters and improving the effectiveness and comfort of respiratory support systems.

High-flow nasal cannula oxygen therapy versus non-invasive ventilation in healthy respiratory physicians: a non-randomized study.

High-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) are commonly used for respiratory support. This study aims to first establish whether to use HFNC or NIV based on comfort levels, and subsequently evaluate diaphragmatic function under equivalent comfort levels to determine the optimal modality for clinical application. A self-controlled, non-randomized study was conducted with 10 healthy respiratory physicians as participants. Each subject was exposed to different HFNC settings, including flow rates of 20, 40, and 60 L/min at both 33 and 37°C. Additionally, participants were assessed under NIV mode. Comfort levels as the primary outcome were evaluated using the Visual Numerical Scale (VNS). Meanwhile, vital signs and diaphragmatic mobility were monitored through an electrocardiograph and ultrasound. HFNC at a flow rate of 20 L/min provided greater comfort than NIV. However, as the flow rate increased, this comfort benefit decreased. At 40 L/min, comfort levels were similar between HFNC and NIV, while at 60 L/min, HFNC was less comfortable than NIV. Notably, temperature variations between 33 and 37°C had no significant effect on comfort. In addition, under conditions of similar comfort, HFNC demonstrated slightly greater diaphragmatic mobility compared to NIV. Our study indicated HFNC was the preferred choice for providing respiratory support at low to moderate flow rates in healthy volunteers not requiring respiratory support. By contrast, at higher flow rates, NIV discomfort was lower than HFNC discomfort.

Efficacy and safety of nasal high-frequency oscillation in preventing intubation in very-low-birth-weight infants with respiratory distress syndrome.

Invasive mechanical ventilation in very-low-birth-weight infants (VLBWI) was associated with immediate and long-term complications. Nasal high-frequency oscillation (nHFO) has recently become a new non-invasive ventilation (NIV) mode for treating respiratory failure in VLBWI. This study aimed to investigate the safety and efficacy of nHFO as an alternative respiratory support to prevent intubation in VLBWI. A retrospective analysis was conducted using the clinical data of 42 VLBWIs with respiratory distress syndrome (RDS) who were treated in our department from August 2018 to August 2020 and met the selection criteria. nHFO was used as a rescue strategy in 32 infants and a prophylactic strategy in 10 infants. It was observed that out of 42 cases, 30 cases (71.4%) were able to avoid intubation within 72h, while 23 cases (54.8%) were successfully switched to another NIV mode from nHFO. There was a significant decrease in pCO2 and an increase in pH 1h after using nHFO in the success group. Two cases (4.8%) of feeding intolerance associated with nHFO were noted. This study showed that nHFO as alternative respiratory support for preterm infants with RDS might be safe and effective in reducing the need for intubation.

A Comparative Study of Different Modes of Noninvasive Ventilation as Postextubation Respiratory Support and Their Effect on Hemodynamic Changes in Preterm infants

Abstract Background Noninvasive respiratory support has reduced the need for invasive mechanical ventilation (MV). This may reduce the incidence of bronchopulmonary dysplasia (BPD) in preterm infants. There are many different forms of noninvasive respiratory support which include nasal continuous positive airway pressure (NCPAP), Non-invasive high-frequency oscillatory ventilation (NHFOV) and High velocity nasal insufflation (HVNI). Little is known about the hemodynamic changes that occur during NIV, particularly during the weaning phase when lung compliance has improved. Aim of the Work To evaluate the outcome of NHFOV and Hi-VNI Vapotherm in comparison to nasal CPAP as a post extubation noninvasive respiratory support in preterm neonates. 2ry aim is to assess hemodynamic changes during periods of non-invasive respiratory support including echocardiographic, cerebral blood flow and mesenteric blood flow changes. Study Design This was a randomized control prospective study at Ain Shams Children Hospital, Cairo, Egypt. conducted on 61 mechanically ventilated preterm neonates 32-36 weeks gestational age with RDS, who were on invasive ventilatory support then extubated to non-invasive mode: Group A, 21 preterm neonates extubated on NCPAP. Group B, 20 preterm neonates extubated on NHFOV and Group C, 20 preterm extubated on Hi-VNI Vapotherm. The Three groups were studied for the need for re-intubation within the first 24 hours after extubation, length of hospital stay and duration of non- invasive ventilation (NIV), Retinopathy of prematurity (ROP), air leak syndromes, Intraventricular hemorrhage (IVH), Necrotizing enterocolitis (NEC), nasal trauma, Bronchopulmonary dysplasia (BPD) and mortality. Also assessing hemodynamic changes during and after weaning of non-invasive respiratory support including echocardiography, Anterior cerebral artery resistive index (ACA) RI, Middle cerebral arteries resistive index (MCA) RI, and superior mesenteric artery resistive index (SMA) RI. Results PaCO2 was unchanged from preextubation levels after weaning in the NCPAP and NHFOV but increased significantly after weaning from vapotherm. NCPAP had the shortest length of hospital stay median (IQR) 18 while the NHFOV has the longest duration of hospital stay median (IQR) 28. NHFOV had the least failure rate10% while post extubation to Vapotherm had the highest failure rate 40%, yet this did not reach statistical significance. Significant association found between failure on vapotherm and birth weight less than or equal to 1.75 kg with OR (95% CI) of 77.00 (4.114 – 1441.049) and with p-value = 0.004. A significant higher incidence of mortality was found in vapotherm failed group as compared to the succeed group (75% vs. 0%, p = 0.03). There was significantly higher nasal trauma among NHFOV group compared to the NCPAP and Vapotherm groups (P = 0.001). NHFOV had the least mortality rate 0% while post extubation to Vapotherm had the highest mortality rate 30%, yet this did not reach statistical significance. NCPAP had the least incidence of sepsis while the vapotherm had the highest incidence (P = 0.02). No significant difference between the 3 modes of noninvasive respiratory support in the occurrence of comorbidities as NEC, IVH, ROP and BPD. By Doppler echocardiography, NHFOV showed that both RVO, SVC flow significantly increased after weaning. ACA RI significantly increased after weaning from NHFOV. Also, it showed significant increase in RVO after weaning vapotherm with no significant effect on cerebral blood flow. NCPAP didn’t have significant effect on systemic &amp; pulmonary venous return by Doppler echocardiography. Although it showed that both ACA and MCA RI significantly increased after weaning. Conclusion Overall, these findings suggest that NHFOV may be a favorable option for respiratory support in preterm infants following extubation, as it was associated with better outcomes compared to NCPAP and Vapotherm. However, further research is needed to fully understand the potential benefits and risks of each mode of noninvasive respiratory support in this population. Infants in the Hi-VNI Technology group had significantly lower nasal trauma scores than those in the NCPAP and NHFOV groups with increased failure rate in preterm infants with a birth weight less than or equal to 1.75 kgs.

Ventilator performances for non-invasive ventilation: a bench study

IntroductionA wide range of recent ventilators, dedicated or not, is available for non-invasive ventilation (NIV) in respiratory or intensive care units (ICU). We conducted a bench study to compare their...

Ventilasi Noninvasif pada Obstructive Sleep Apnea dan Obesity Hypoventilation Syndrome

Chronic respiratory disease such as obstructive sleep apnea (OSA) and obesity-hypoventilation syndrome (OHS) remain are respiratory sleeping disorder that gradually affect quality of life. Comprehensive treatment such as the use of non-invasive ventilation (NIV) is a method adopted to improve the patient’s quality of life. The correct choice of NIV mode, mask and titration methods will provide optimal therapeutic effects to the patient. This article review lays out an update on the use of non-invasive ventilation as the treatment of OSA and OHS.

Non-Invasive Ventilation with Neurally Adjusted Ventilatory Assist (NAVA) Improves Extubation Outcomes in Extremely Low-Birth-Weight Infants.

Objective: This study investigates the effectiveness of extubation from conventional mechanical ventilation using an endotracheal tube (MVET) compared to synchronized non-invasive positive-pressure ventilation (sNIPPV) using neurally adjusted ventilatory assist (NAVA) and conventional non-invasive positive-pressure ventilation (NIPPV) in extremely low-birth-weight (ELBW) infants. Methods: An institutional review board (IRB) approved this study (#12175) to conduct a single-center randomized control trial including 60 ELBW infants assigned in a one-to-one computer-generated scheme to either sNIPPV using NAVA or NIPPV. The primary outcome involved the need for reintubation, and the secondary outcome involved the assessment of moderate/severe BPD, defined as an oxygen requirement at 36 weeks, as in #NCT03613987 (clinicaltrials.gov). Results: There were 60 ELBW infants enrolled and randomized. The overall gestational age was 26 (1.5) weeks, and the birth weight was 773 (157) g [mean (SD)]. There were no statistically significant differences between the NAVA and NIPPV patient characteristics. There was a 41% extubation failure rate in the NIPPV group and 35% in the NAVA group (p = NS). The NAVA group had less moderate and severe BPD (p = 0.03), a shorter oxygen therapy duration (p = 0.002), a decreased length of stay (p = 0.03), and less need for home oxygen (0, 43%; p = 0.0004). Conclusions: This study found similar extubation failure rates among ELBW infants as in prior studies. However, the NAVA group had lower rates of moderate/severe BPD and need for oxygen at discharge, as well as shorter oxygen therapy duration and length of stay. The use of NAVA may be a reasonable alternative mode of non-invasive ventilation in the ELBW population.

New noninvasive modalities in long-term pediatric ventilation: a scoping review.

Long-term noninvasive ventilation modalities for the pediatric population have undergone a continuous evolution. Hybrid noninvasive ventilation modalities have been recently introduced in clinical practice. Combining the advantages of conventional ventilation, hybrid modes use algorithms that automatically adjust the ventilator's settings to achieve a predefined ventilation target. Most of the recommendations on the use and settings of hybrid noninvasive ventilation modalities in children are derived from adult experience. Therefore, there is a lack of evidence on its implementation in pediatric chronic respiratory diseases. This scoping review aims to map the existing information regarding the use of hybrid ventilation modalities in the pediatric population and identify knowledge or research gaps. We performed a literature search using MEDLINE and Pubmed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We included 13 studies (ten studies on average volume-assured pressure-support ventilation; two studies on intelligent volume-assured pressure-support ventilation; and one study on adaptive servoventilation). The use of new noninvasive ventilation modes in the pediatric population has been applied for the treatment of neuromuscular and hypoventilation syndromes as an alternative therapeutic option in the case of the failure of conventional noninvasive ventilation. Their widespread use has been hampered by the limited evidence available. Longitudinal studies on a larger number of patients are needed to confirm their effectiveness and evaluate their long-term clinical and functional outcomes.

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

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); however, 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. 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%). A total of 5/11 units reported frequent nHFOV use (in two 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%). Face/nasal masks and short binasal prongs are 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. Only three of the NICUs had a written protocol for nHFOV use. 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.

Noninvasive High Frequency Ventilation as a Post-extubation Respiratory Support in Preterm Neonates

Abstract Background Noninvasive mechanical ventilation aims to provide respiratory support without the pulmonary and non-pulmonary complications associated with invasivemechanical ventilation including infection, subglottic stenosis, air leak syndrome and bronchopulmonary dysplasia (BPD). There is a notable increase in use of various types of noninvasive respiratory support post extubation to ensure the sucesss of extubation and avoid re-intubation. Noninvasive high frequency ventilation (NHFOV) is a new mode of noninvasive ventilation which is achieved through the use of noninvasive continuous flow with superimposed oscillations combining the benefits of high frequency oscillatory ventilaltion and noninvasive ventilation. Aim of Work The primary aim of the study is to compare re-ventilation rate between noninvasive positive pressure ventilation (NIPPV) and NHFOV when used as post extubation respiratory support. Secondary aim was to compare workof breathing, chest X-ray grade, incidence of pneumothorax and duration to reach full enteral intake between the 2 groups. Methodology Sixty preterm neonates with respiratory distress syndrome (RDS) who received invasive mechanical ventilation for more than 48 hours were included in this randomized controlled trial. Patients were randomly allocated post-extubation toNIPPV or NHFOV. The 2 groups were matched regarding weight, gestational age and comorbidities during invasive ventilation. Patients were compared regarding re-ventilation rate, work of breathing assessed by Downes score, chest X-ray grade, incidence of pneumothorax and duration to reach full enteral intake. Results Lower re-ventilation rate was found in NHFOV group (23.3%) compared to NIPPV group (30.0%). Median duration to reach full intake was shorter in NHFOV group (8 days) compared to NIPPV group (9.5 days) however, theseresults didn’t reach statistically significant difference (P value = 0.559 value and0.299 respectively). No difference was found between studied groups regarding work of breathing assessed by Downes’ score (P value = 0.634) nor regarding chest X-ray grades (p value= 0.902). Incidence of pneumothorax was equal in NHFOV group compared to NIPPV group with p value of 0.313. Conclusion NHFOV is a promising safe noninvasive mode for neonates post-extubation.

Non-Invasive High Frequency Oscillatory Ventilation versus Continuous Positive Airway Pressure in Preterm Neonates With Respiratory Distress Syndrome

Abstract Background Respiratory distress syndrome (RDS) is the main cause of respiratory failure in preterm neonates, its incidence varies from 80% to 25% depending on gestational age. When optimal prenatal care is provided, the best approach to treat RDS, according to several recent trials, consists of providing continuous positive airway pressure (CPAP) from the first minutes of life using short binasal prongs or masks, followed by early selective surfactant administration for babies with worsening oxygenation and/or increasing work of breathing. Any effort must be done to minimize the time under invasive mechanical ventilation (IMV). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a new mode of non-invasive ventilation that connects non-invasive circuits to high-frequency ventilators, through which gas exchange is achieved by the superposition of high-frequency oscillation over continuous positive flow. Compared with other non-invasive ventilation modes, nHFOV combines the advantages of nCPAP and high-frequency ventilation, making it more effective at maintaining alveolar stability, eliminating CO2, and limiting barotrauma. Objective To investigate the effectiveness of nasal high frequency oscillatory ventilation in comparison to nCPAP as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome. Methods This randomized controlled trial that was conducted on 90 neonates diagnosed with RDS at the Neonatal Intensive Care Units (NICUs), Ain Shams University Hospitals throughout six months. Results In the current study, there was a significant decrease in FiO2 needs in nHFOV group vs. nCPAP group, the median (IQR) (30% (21 to 37) vs. 31% (30 to 40) respectively, P-value=0.030), but non significant difference in RDS according to total Silverman score in nHFOV group vs. nCPAP group with median (IQR) total Silverman score (4 (4 to 5)vs. 4 (3 to 6) respectively, P-value= 0.474). Conclusion Using nHFOV is better than nCPAP in decreasing the need of FiO2.

Effects of high frequency non-invasive ventilation in premature newborn infants: systematic review protocol

Introduction: Premature birth is a condition, which can be induced by several factors. High Frequency non-invasive ventilation is a promising new mode of non-invasive ventilation that aims to offer adequate ventilation and oxygenation, but much has yet been discussed about its effectiveness and safety. Objective: To evaluate the effectiveness and safety of high frequency non-invasive ventilation in premature infants. Methods: To this end, we will carry out a systematic review. The study protocol was recorded on the Prosperous Platform. We will include premature newborns who used high-frequency non-invasive ventilation requiring ventilation as an initial support, after extubation or as a rescue mode (after failure of initial non-invasive therapy). The searches will be carried out in the databases: Medical Literature Analysis and Retrieval System Online (Medline) via Pubmed, Excerpta Medica dataBASE (Embase) via Elsevier, Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library, Latin American and Caribbean Literature in Health Sciences (LILACS) via the Virtual Health Library Portal and Physiotherapy Evidence Database We will evaluate the methodological rigor of the included studies and the certainty of the evidence of the main outcomes of the systematic review using Cochrane's Risk of Bias 2.0 tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. The selection of studies, data extraction, evaluation of the bias of the included studies and evaluation of the certainty of the evidence will be carried out by two independent researchers. Expected Results: The results of this review are expected to present a critical and up-to-date summary of the topic and facilitate safer decision-making by physiotherapists regarding the best recommendation for ventilatory support in the NICU, based on the best scientific evidence currently available.

Comparative Effect of High-Frequency Nasal Cannula and Noninvasive Ventilation on the Work of Breathing and Postoperative Pulmonary Complication after Pediatric Congenital Cardiac Surgery: A Prospective Randomized Controlled Trial.

Various forms of commonly used noninvasive respiratory support strategies have considerable effect on diaphragmatic contractile function which can be evaluated using sonographic diaphragm activity parameters. To compare the magnitude of respiratory workload decreased as assessed by thickening fraction of the diaphragm and longitudinal diaphragmatic strain while using high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) modes [nasal intermittent positive pressure ventilation (NIPPV) and bilevel positive airway pressure (BiPAP)] in pediatric patients after cardiothoracic surgery. This prospective randomized controlled trial was performed at a tertiary care surgical intensive care unit in postcardiac surgery patients aged between 1 and 48 months, who were randomly allocated into three groups: 1) HFNC (with flows at 2 L/kg/min), 2) NIPPV via RAMS cannula in PSV mode (pressure support 8 cmH2O, PEEP 5 cmH2O), and 3) BiPAP in nCPAP mode (CPAP of 5 cmH2O). Measurements were recorded at baseline after extubation (R0) and subsequently every 12 hourly (R1, R2, R3, R4, R5) at 12, 24, 36, 48, and 60 hours respectively until therapy was discontinued. Sixty patients were included, with 20 patients each in the NIPPV group, HFNC group, and BiPAP group. Longitudinal strain at crura of diaphragm was lower in the BiPAP group as compared to HFNC group at R2-R4 [R2 (-4.27± -2.73 vs - 8.40± -6.40, P = 0.031), R3 (-5.32± -2.28 vs -8.44± -5.6, P = 0.015), and R4 (-3.8± -3.42 vs -12.4± -7.12, P = 0.040)]. PFR was higher in HFNC than NIPPV group at baseline and R1-R3[R0 (323 ± 114 vs 264 ± 80, P = 0.008), R1 (311 ± 114 vs 233 ± 66, P = 0.022), R2 (328 ± 116 vs 237 ± 4, P = 0.002), R3 (346 ± 112 vs 238 ± 54, P = 0.001)]. DTF and clinical parameters of increased work of breathing remain comparable between three groups. The rate of reintubation (within 48 hours of extubation or at ICU discharge) was 0.06% (1 in NIPPV, 1 in BiPAP, 2 in HFNC) and remain comparable between groups (P = 1.0). BiPAP may provide better decrease in work of breathing compared to HFNC as reflected by lower crural diaphragmatic strain pattern. HFNC may provide better oxygenation compared to NIPPV group, as reflected by higher PFR ratio. Failure rate and safety profile are similar among different methods used.

Energy Dense Feeding in Premature Infants and Its’ Associated Outcomes

COVID-19 infection in pregnant mothers is associated with higher risk of intrauterine growth retardation and premature births. Very low birth weight infants are more susceptible to neurodevelopmental and chronic respiratory problems. An infant delivered at 33 weeks via caesarean section to a COVID-19 Stage 5A positive mother, weighing 1.43kg at birth. She was kept nil by mouth with parenteral nutrition (PN) support since day five of life until referred to dietitian on day 22 of life for enteral nutrition (EN) establishment. Feeding was administered intermittently via oro-gastric Ryle’s Tube. She was kept under non-invasive ventilation (NIV) mode and had difficulty in weaning from ventilation, leading to slow feeding progress. Initially, enteral trophic feeding was administered using premature infant formula fortified with modular products. In the later stage of feeding, modular products were tapered off and the formula was concentrated. Frequency of bowel output when using fortified formula is lesser compared to when using concentrated and supplemented formula. There is no significant difference in renal profile observed in both stages of feeding. Increasing energy intake using easily digestible sources is preferable as opposed to concentrating feeds even further due to concerns about osmolality and excess administration of other solutes. Intermittent bolus feeding mode may have an effect on dependency on oxygen since intermittent feeds can decrease tidal volume, minute ventilation and dynamic compliance. Additional research is necessary to establish optimal caloric density and nutritional compositions of feedings, feeding mechanisms and its’ effect on feeding tolerance.

Efficay of high-flow nasal cannula in the paediatric population: A systematic evidence map

ProblemHigh-flow nasal cannula (HFNC) has been widely used in paediatric medicine as a non-invasive ventilation mode for respiratory support. However, the differences in its efficacy across different diseases and intervention types remain poorly understood. Eligibility criteriaAn extensive literature search was performed across multiple academic databases to investigate the systematic reviews and meta-analyses of HFNC. SampleThis study included 35 systematic reviews and meta-analyses, which collectively examined 355 randomised controlled trials and assessed 51 outcome indicators. ResultsThe findings suggest that the existing clinical research evidence predominantly supports the therapeutic efficacy of HFNC. Notably, there is a significant focus on treating acute lower respiratory infection, hypoxaemia, bronchiolitis, and respiratory distress syndrome following extubation. However, concerning the respiratory status, the existing clinical research evidence mainly demonstrates the therapeutic benefits in post-extubation respiratory support and primary respiratory support. ConclusionsThe research on HFNC has witnessed significant expansion, primarily focusing on respiratory disorders, post-extubation respiratory support, conscious sedation, and related fields. The evidence mapping provides a systematic and comprehensive overview of the available evidence on HFNC therapy in paediatric patients. ImplicationsThis study systematically and comprehensively assessed the clinical subjects and populations involved in HFNC therapy. Notably, this study analyzed the trends, current status, and evidence gaps of research, and furnished decision-makers and relevant researchers with a more comprehensive reference basis.

High-flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP) vs nasal intermittent positive pressure ventilation as primary respiratory support in infants of ≥ 32 weeks gestational age (GA): study protocol for a three-arm multi-center randomized controlled trial

BackgroundHealth problems in neonates with gestational age (GA) ≥ 32 weeks remain a major medical concern. Respiratory distress (RD) is one of the common reasons for admission of neonates with GA ≥ 32 weeks. Noninvasive ventilation (NIV) represents a crucial approach to treat RD, and currently, the most used NIV modes in neonatal intensive care unit include high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and nasal intermittent positive pressure ventilation. Although extensive evidence supports the use of NIPPV in neonates with a GA < 32 weeks, limited data exist regarding its effectiveness in neonates with GA ≥ 32 weeks. Therefore, the aim of this study is to compare the clinical efficacy of HFNC, CPAP, and NIPPV as primary NIV in neonates with GA ≥ 32 weeks who experience RD.MethodsThis trial is designed as an assessor-blinded, three-arm, multi-center, parallel, randomized controlled trial, conducted in neonates ≥ 32 weeks’ GA requiring primary NIV in the first 24 h of life. The neonates will be randomly assigned to one of three groups: HFNC, CPAP or NIPPV group. The effectiveness, safety and comfort of NIV will be evaluated. The primary outcome is the occurrence of treatment failure within 72 h after enrollment. Secondary outcomes include death before discharge, surfactant treatment within 72 h after randomization, duration of both noninvasive and invasive mechanical ventilation, duration of oxygen therapy, bronchopulmonary dysplasia, time to achieve full enteral nutrition, necrotizing enterocolitis, duration of admission, cost of admission, air leak syndrome, nasal trauma, and comfort score.DiscussionCurrently, there is a paucity of data regarding the utilization of NIPPV in neonates with GA ≥ 32 weeks. This study will provide clinical evidence for the development of respiratory treatment strategies in neonates at GA ≥ 32 weeks with RD, with the aim of minimizing the incidence of tracheal intubation and reducing the complications associated with NIV.Trial registrationChinese Clinical Trial Registry: ChiCTR2300069192. Registered on March 9, 2023, https://www.chictr.org.cn/showproj.html?proj=171491.

Study on clinical profile of ventilated children in a pediatric intensive care unit of tertiary care centre

Background: Mechanical ventilation constitutes a major therapeutic modality in intensive care, so care of patients requiring ventilatory support is an integral part of the critical care unit. Very less data is available from developing countries regarding use of Mechanical Ventilation, its complication and outcomes which is a challenge for modern day intensivists. Objectives were to study clinical profile of ventilated children in a PICU of tertiary care centre. Methods: Present prospective cross-sectional study was conducted on ventilated children admitted at PICU of Dr. VMGMC hospital, Solapur. The study included demographics, clinical profile, indication for ventilation, length of hospital stays, outcome. Results: Out of 300 children, 170 were males. Most the children were from age group &lt;5 years. Difficulty in breathing was seen in 188 cases, fever in 55%, 100 patients had acute CNS infections, 82 cases had bronchopneumonia, 85 cases respiratory failure was the indication for intubation. The duration of the mechanical ventilation was more in CNS cases, RS cases, sepsis cases. 165 cases got recovered successfully. Conclusions: Mechanical ventilation is one of the major supportive modalities used in critical care all over the world and is also used in many of the sick children in government tertiary care centre. Despite of its life saving advantages, mechanical ventilation is associated with complication. Early use of HHFNC, CPAP/BiPAP and other non-invasive modes of ventilation decrease the need for invasive mechanical ventilation.

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

Nasal high-frequency oscillatory ventilation (nHFOV) and synchronized nasal intermittent positive pressure ventilation (sNIPPV) were the new modes of noninvasive ventilation. This study's aim was to clarify as to which of the nHFOV and sNIPPV modes was superior in preventing postextubation failure or reintubation in neonates. An open-label parallel randomized study was performed. Extubated preterm and term neonates were randomly allocated into nHFOV or sNIPPV modes; the reintubation rate was evaluated within 7 days after extubation between the two modes. Subgroup analyses were performed for preterm (gestational age <37 weeks) and very preterm (gestational age <32 weeks) neonates. The sample calculation was 1,050 neonates; however, this trial was stopped early as enrollment was too slow. From July 2020 to June 2022, 202 neonates were assessed for eligibility and 69 neonates were excluded. Finally, 133 neonates were randomly allocated to the study interventions (nHFOV = 67, sNIPPV = 66). The median gestational age and birth weight were 33 (30-37) weeks and 1,910 (1,355-2,836) g, respectively. The reintubation rate within 7 days did not significantly differ between the groups (nHFOV [5/67, 7%] vs. sNIPPV [4/66, 6%]); risk difference [95% confidence interval] = 0.01 [-0.08 to 0.11]; p = 0.99), including preterm (nHFOV [4/55, 7%] vs. sNIPPV [3/44, 7%]) and very preterm (nHFOV [3/25, 12%] vs. sNIPPV [3/25, 12%]) neonates. After neonatal extubation, there was no significant difference of reintubation rates within 7 days between nHFOV and sNIPPV. This trial has been registered in the ClinicalTrials.gov database ( https://clinicaltrials.gov/ct2/show/NCT04323397 ). First posted registration on March 26, 2020. · There was no significant difference of reintubation rates between nHFOV and sNIPPV.. · During nHFOV support, one neonate developed pneumomediastinum.. · During sNIPPV support, one neonate developed pulmonary hemorrhage..

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.