Nasal high-frequency oscillatory ventilation and CO2 removal: A randomized controlled crossover trial

Roberto Bottino, Federica Pontiggia, Cinzia Ricci, Alessandro Gambacorta, Angela Paladini, Vladimiras Chijenas, Arunas Liubsys, Jurate Navikiene, Ausrine Pliauckiene, Domenica Mercadante, Mariarosa Colnaghi, Milena Tana, Chiara Tirone, Alessandra Lio, Claudia Aurilia, Roberta Pastorino, Velia Purcaro, Gianfranco Maffei, Pio Liberatore, Chiara ConsigliCristina Haass, Gianluca Lista, Massimo Agosti, Fabio Mosca, Giovanni Vento

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To compare short-term application of nasal high-frequency oscillatory ventilation (nHFOV) with nasal continuous positive airway pressure (nCPAP).

WORKING HYPOTHESIS: nHFOV improves CO2 removal with respect to nCPAP in preterm infants needing noninvasive respiratory support and persistent oxygen supply after the first 72 h of life.

STUDY DESIGN: Multicenter non-blinded prospective randomized crossover study.

PATIENT SELECTION: Thirty premature infants from eight tertiary neonatal intensive care units, of mean ± SD 26.4 ± 1.8 weeks of gestational age and 921 ± 177 g of birth weight.

METHODOLOGY: Infants were randomly allocated in a 1:1 ratio to receive a starting treatment mode of either nCPAP or nHFOV delivered by the ventilator CNO (Medin, Germany), using short binasal prongs of appropriate size. A crossover design with four 1-h treatment periods was used, such that each infant received both treatments twice. The primary outcome was the mean transcutaneous partial pressure of CO2 (TcCO2 ) value during the 2-h cumulative period of nHFOV compared with the 2-h cumulative period of nCPAP.

RESULTS: Significantly lower TcCO2 values were observed during nHFOV compared with nCPAP: 47.5 ± 7.6 versus 49.9 ± 7.2 mmHg, respectively, P = 0.0007. A different TcCO2 behavior was found according to the random sequence: in patients starting on nCPAP, TcCO2 significantly decreased from 50.0 ± 8.0 to 46.6 ± 7.5 mmHg during nHFOV (P = 0.001). In patients starting on nHFOV, TcCO2 slightly increased from 48.5 ± 7.8 to 49.9 ± 6.7 mmHg during nCPAP (P = 0.13).

CONCLUSIONS: nHFOV delivered through nasal prongs is more effective than nCPAP in improving the elimination of CO2 .

Original languageEnglish
Pages (from-to)1245-1251
Number of pages7
JournalPediatric Pulmonology
Issue number9
Publication statusPublished - Sep 2018


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