Ali Yaser A H, Seshia Mary M, Ali Ebtihal, Alvaro Ruben
Department of Pediatrics and Child Health, Section of Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada.
Am J Perinatol. 2022 Apr;39(6):666-670. doi: 10.1055/s-0040-1718738. Epub 2020 Oct 19.
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, < 0.005), but there were no significant changes in the PCO level (52 [ ± 9.8] vs. 52 [ ± 8.6] mm Hg, = 0.8), or the FiO requirement (0.39 ± 0.19 vs. 0.33 ± 0.10, = 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 PCO 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..
本研究旨在评估经鼻高频振荡通气（NHFOV）预防早产儿再次插管的可行性。
这是一项对单中心新生儿重症监护病房中所有接受NHFOV治疗的早产新生儿进行的回顾性队列研究。
27例患者（出生体重：765±186g，胎龄：28±2周）共接受了32次NHFOV治疗。在32次治疗中，有10次在拔管后立即将NHFOV作为无创通气（NIV；预防性治疗）的主要模式，22次作为“挽救性治疗”（NCPAP或双相CPAP治疗失败）。NHFOV治疗成功22次（69%），10次（31%）在72小时内需要再次插管。在挽救性治疗组中，呼吸暂停的平均（标准差[SD]）次数显著减少（0.9±1.07对0.3±0.29，P<0.005），但开始NHFOV治疗前后PCO₂水平（52[±9.8]对52[±8.6]mmHg，P=0.8）或FiO₂需求（0.39±0.19对0.33±0.10，P=0.055）无显著变化。
NHFOV作为拔管后NIV的预防性或挽救性模式是可行的，且与呼吸暂停次数减少相关，PCO₂或氧需求无显著变化。需要进行精心设计的随机对照试验来确定这种治疗方式的适应症、临床结局和安全性。
·NHFOV是一种新兴的无创通气模式。·NHFOV作为无创通气的预防性或挽救性模式是可行的。·需要精心设计的随机对照试验来评估NHFOV的疗效和安全性。
