Non-invasive high-frequency oscillatory ventilation in preterm infants: a randomised controlled cross-over trial. Issue 4 (16th September 2017)

• Record Type: Journal Article
• Authors: Klotz, Daniel; Schneider, Hendryk; Schumann, Stefan; Mayer, Benjamin; Fuchs, Hans
• Is Part Of: Archives of disease in childhood. Volume 103:Issue 4(2018)
• Page Start: F1
• Page End: F5
• Publication Date: 2017-09-16
• Subjects: non-invasive ventilation -- high frequency oscillatory ventilation -- preterm -- neonate -- carbon dioxide; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2017-313190
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Objective: Non-invasive high-frequency oscillatory ventilation (nHFOV) has recently been described as a novel mode of respiratory support for premature infants. This study was designed to determine whether nHFOV decreases CO2 partial pressure (pCO2 ) in premature infants more effectively than non-invasive continuous positive airway pressure (nCPAP). Design: Non-blinded prospective randomised controlled cross-over study. Setting: University Medical Center tertiary neonatal intensive care unit. Patients: 26 premature infants of 27±2 weeks of gestational age after extubation or non-invasive surfactant treatment. Interventions: Infants were treated with 4 hours of nHFOV and 4 hours of nCPAP in a cross-over design. The sequence of the ventilation mode was randomly allocated. Main outcome measures: The primary outcome measure was pCO2 of arterial or arterialised blood 4 hours after commencing the respective mode of respiratory support. Secondary outcome criteria included events of apnoea and bradycardia, respiratory rate, heart rate, pain and/or discomfort, mean airway pressure, fraction of inspired oxygen and failure of non-invasive respiratory support. Results: pCO2 after 4 hours of nHFOV was similar compared with 4 hours of nCPAP (p=0.33). pCO2 was 54.8 (14.6) vs 52.7 (9.3) mm Hg mean (SD) for the nHFOV–nCPAP period (n=13) and 49.0 (8.1) vs 47.7 (9.5) mm Hg for the nCPAP–nHFOV period (n=13). There was no difference in any of the secondary outcome measures. nHFOV was terminated prematurely in five cases for predefined failure criteria (p=0.051). Conclusions: We could not demonstrate an increased carbon dioxide clearance applying nHFOV compared with nCPAP in this cohort of preterm infants. Trial registration number: DRKS00007171, results.