Department of Neonatology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, 244, A J C Bose Road, Kolkata, PIN-700020, India.
Department of Pharmacology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, 244, A J C Bose Road, Kolkata, PIN-700020, India.
Eur J Pediatr. 2021 Oct;180(10):3151-3160. doi: 10.1007/s00431-021-04084-1. Epub 2021 Apr 23.
Early and successful extubation prevents several morbidities in preterm newborns. Several secondary non-invasive respiratory modalities exist but with their merits and demerits. Given the benefits of nasal high-frequency oscillatory ventilation (nHFOV), we tried to examine whether nHFOV could reduce reintubation rates compared to nasal intermittent positive pressure ventilation (NIPPV) during the post-extubation phase in preterm infants. Stratified randomisation based on gestational age was done for 86 mechanically ventilated preterm infants between 26 and 36 weeks of gestation within 2 weeks of age to receive either nHFOV or NIPPV post-extubation. The main objective was to compare extubation failure within 72 h following extubation and secondarily feed intolerance, intraventricular haemorrhage (IVH) (> grade 3), composite bronchopulmonary dysplasia (BPD)/mortality, composite duration of oxygen supplementation/ventilation support and SpO2/FiO2 ratio. No statistical difference was noted for primary outcome (RR 0.8, 95% CI: 0.23 to 2.78; p = 1.00) and secondary outcomes. However, nHFOV appeared possibly better in respect to feed tolerance rates and pCO2 washout.Conclusion: Extubation failure within 72 h in infants less than 37 weeks of gestation did not differ between the two groups. However, nHFOV seems promising in reducing enteral feeding issues and pCO2 elimination. Larger multicentre studies are required for exploring benefits of nHFOV.Trial registration: www.ctri.nic.in id CTRI/2019/07/020055, registration date July 5, 2019 What is Known: • NIPPV is superior to nCPAP as a secondary mode of respiratory support. • Synchronisation is preferred for optimum ventilation. What is New: • nHFOV, a novel non-invasive respiratory modality without need for synchronisation, appears promising as a secondary mode subject to further trials. • It seems promising in reducing enteral feeding issues and pCO2 elimination.
早期并成功地拔管可预防早产儿的多种并发症。存在几种次要的无创呼吸方式，但各有利弊。鉴于高频振荡通气（nHFOV）的益处，我们试图检查在 26 至 36 周龄的机械通气早产儿中，与经鼻间歇正压通气（NIPPV）相比，nHFOV 在拔管后的阶段是否可以降低再插管率。在 2 周龄内，对 86 名接受机械通气的早产儿进行基于胎龄的分层随机分组，使其在拔管后接受 nHFOV 或 NIPPV。主要目标是比较拔管后 72 小时内的拔管失败率，次要终点包括喂养不耐受、脑室内出血（IVH）（> 3 级）、复合支气管肺发育不良（BPD）/死亡率、复合氧疗/通气支持时间以及 SpO2/FiO2 比值。主要结局（RR 0.8，95%CI：0.23 至 2.78；p = 1.00）和次要结局均无统计学差异。然而，nHFOV 在喂养耐受率和 pCO2 洗脱方面似乎更好。结论：在胎龄不足 37 周的婴儿中，72 小时内的拔管失败在两组之间没有差异。然而，nHFOV 似乎有望减少肠内喂养问题和 pCO2 的消除。需要更大规模的多中心研究来探索 nHFOV 的益处。试验注册：www.ctri.nic.in id CTRI/2019/07/020055，注册日期 2019 年 7 月 5 日 已知：•NIPPV 作为二级呼吸支持优于 nCPAP。•同步是优化通气的首选。 新发现：•nHFOV，一种不需要同步的新型无创呼吸方式，似乎有希望成为一种二级模式，但需要进一步的试验。•它似乎有望减少肠内喂养问题和 pCO2 的消除。
