Nasal High-Frequency Oscillatory Ventilation in Preterm Infants With Respiratory Distress Syndrome and ARDS After Extubation: A Randomized Controlled Trial

Long Chen; Li Wang; Juan Ma; Zhichun Feng; Jie Li; Yuan Shi

doi:10.1016/j.chest.2019.01.014

Nasal High-Frequency Oscillatory Ventilation in Preterm Infants With Respiratory Distress Syndrome and ARDS After Extubation: A Randomized Controlled Trial

Chest. 2019 Apr;155(4):740-748. doi: 10.1016/j.chest.2019.01.014.

Authors

Long Chen¹, Li Wang², Juan Ma², Zhichun Feng³, Jie Li⁴, Yuan Shi⁵

Affiliations

¹ Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China.
² Department of Pediatrics, Daping Hospital of the Army Medical University, Chongqing, China.
³ Affiliated BaYi Children's Hospital, PLA Army General Hospital, Beijing, China.
⁴ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁵ Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China; Department of Pediatrics, Daping Hospital of the Army Medical University, Chongqing, China. Electronic address: shiyuan@hospital.cqmu.edu.cn.

PMID: 30955572
DOI: 10.1016/j.chest.2019.01.014

Abstract

Background: 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.

Methods: 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 37 weeks' 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 1 week and the Pco₂ level within 6 h.

Results: 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 vs 35:68; 95% CI, 0.18-0.70; P = .002), especially in the subgroup with a gestational age of ≤ 32 weeks (12:34 vs 25:20; 95% CI, 0.12-0.68; P = .004). The Pco₂ level was also significant lower in the NHFOV group (49.6 ± 8.7 vs 56.9 ± 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).

Conclusions: NHFOV was shown to be superior to NCPAP in avoiding reintubation, especially in very preterm infants and those infants diagnosed with ARDS.

Trial registry: ClinicalTrials.gov; No.: NCT03140891; URL: www.clinicaltrials.gov.

Keywords: ARDS; nasal CPAP; nasal high-frequency oscillatory ventilation; preterm infant; respiratory distress syndrome.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Airway Extubation / adverse effects*
Female
Follow-Up Studies
Gestational Age
Humans
Infant, Newborn
Infant, Premature*
Intermittent Positive-Pressure Ventilation / methods*
Intubation, Intratracheal
Male
Prospective Studies
Respiratory Distress Syndrome, Newborn / physiopathology
Respiratory Distress Syndrome, Newborn / therapy*
Respiratory Insufficiency / etiology*
Time Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03140891