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Nasal High-Frequency Oscillatory Ventilation in Preterm Infants with Moderate Respiratory Distress Syndrome: A Multicenter Randomized Clinical Trial. 2021

Xingwang Zhu, and Zhichun Feng, and Chengjun Liu, and Liping Shi, and Yuan Shi, and Rangasamy Ramanathan, and
Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China.

To determine whether nasal high-frequency oscillatory ventilation (NHFOV) as a primary mode of respiratory support as compared with nasal continuous airway pressure (NCPAP) will reduce the need for invasive mechanical ventilation in preterm infants (260/7-336/7 weeks of gestational age [GA]) with respiratory distress syndrome (RDS). This multicenter randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a GA of 260/7-336/7 weeks with a diagnosis of RDS were randomly assigned to either the NCPAP (n = 150) or the NHFOV (n = 152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. Treatment failure occurred in 15 of 152 infants (9.9%) in the -NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (95% CI of risk difference: -15.2 to 0.4, p = 0.06). In the subgroup analysis, NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26+0/7-29+6/7weeks of GA (11.9 vs. 32.4%, 95% CI of risk difference: -39.3 to -1.7, p = 0.03) and birth weight <1,500 g (10.4 vs. 29.6%, 95% CI of risk difference: -33.8 to -4.6, p = 0.01). The rate of thick secretions causing an airway obstruction was higher in the NHFOV group than in the NCPAP group (13.8 vs. 5.3%, 95% CI of risk difference: 1.9-15.1, p = 0.01). No significant differences in other secondary outcomes were found between the NHFOV and NCPAP groups. NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26+0/7 and 33+6/7 weeks of GA. In the subgroup analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants <30 weeks of GA.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007234 Infant, Premature A human infant born before 37 weeks of GESTATION. Neonatal Prematurity,Premature Infants,Preterm Infants,Infant, Preterm,Infants, Premature,Infants, Preterm,Premature Infant,Prematurity, Neonatal,Preterm Infant
D007385 Intermittent Positive-Pressure Ventilation Application of positive pressure to the inspiratory phase when the patient has an artificial airway in place and is connected to a ventilator. BIPAP Biphasic Intermittent Positive Airway Pressure,IPPV,Inspiratory Positive-Pressure Ventilation,Ventilation, Intermittent Positive-Pressure,Biphasic Intermittent Positive Airway Pressure,Inspiratory Positive Pressure Ventilation,Intermittent Positive Pressure Ventilation,Positive-Pressure Ventilation, Inspiratory,Positive-Pressure Ventilation, Intermittent,Ventilation, Inspiratory Positive-Pressure,Ventilation, Intermittent Positive Pressure
D012127 Respiratory Distress Syndrome, Newborn A condition of the newborn marked by DYSPNEA with CYANOSIS, heralded by such prodromal signs as dilatation of the alae nasi, expiratory grunt, and retraction of the suprasternal notch or costal margins, mostly frequently occurring in premature infants, children of diabetic mothers, and infants delivered by cesarean section, and sometimes with no apparent predisposing cause. Infantile Respiratory Distress Syndrome,Neonatal Respiratory Distress Syndrome,Respiratory Distress Syndrome, Infant
D006612 High-Frequency Ventilation Ventilatory support system using frequencies from 60-900 cycles/min or more. Three types of systems have been distinguished on the basis of rates, volumes, and the system used. They are high frequency positive-pressure ventilation (HFPPV); HIGH-FREQUENCY JET VENTILATION; (HFJV); and high-frequency oscillation (HFO). High-Frequency Oscillation Ventilation,High-Frequency Positive Pressure Ventilation,Ventilation, High-Frequency,High Frequency Oscillation Ventilation,High Frequency Positive Pressure Ventilation,High Frequency Ventilation,Ventilation, High Frequency,High Frequency Ventilations,High-Frequency Oscillation Ventilations,High-Frequency Ventilations,Oscillation Ventilation, High-Frequency,Oscillation Ventilations, High-Frequency,Ventilation, High-Frequency Oscillation,Ventilations, High Frequency,Ventilations, High-Frequency,Ventilations, High-Frequency Oscillation
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D045422 Continuous Positive Airway Pressure A technique of respiratory therapy, in either spontaneously breathing or mechanically ventilated patients, in which airway pressure is maintained above atmospheric pressure throughout the respiratory cycle by pressurization of the ventilatory circuit. (On-Line Medical Dictionary [Internet]. Newcastle upon Tyne(UK): The University Dept. of Medical Oncology: The CancerWEB Project; c1997-2003 [cited 2003 Apr 17]. Available from: http://cancerweb.ncl.ac.uk/omd/) Airway Pressure Release Ventilation,BiPAP Bilevel Positive Airway Pressure,BiPAP Biphasic Positive Airway Pressure,Bilevel Positive Airway Pressure,Biphasic Positive Airway Pressure,APRV Ventilation Mode,Bilevel Continuous Positive Airway Pressure,Biphasic Continuous Positive Airway Pressure,CPAP Ventilation,Nasal Continuous Positive Airway Pressure,nCPAP Ventilation,APRV Ventilation Modes,Ventilation Mode, APRV,Ventilation Modes, APRV,Ventilation, CPAP,Ventilation, nCPAP
D063087 Noninvasive Ventilation Techniques for administering artificial respiration without the need for INTRATRACHEAL INTUBATION. Non Invasive Ventilation,Non-Invasive Ventilation,Non Invasive Ventilations,Non-Invasive Ventilations,Noninvasive Ventilations,Ventilation, Non Invasive,Ventilation, Non-Invasive,Ventilation, Noninvasive,Ventilations, Non Invasive,Ventilations, Non-Invasive,Ventilations, Noninvasive

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