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 72h 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±177g 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±7.2mmHg, 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±7.5mmHg during nHFOV (P=0.001). In patients starting on nHFOV, TcCO2 slightly increased from 48.5±7.8 to 49.9±6.7mmHg during nCPAP (P=0.13). Conclusions: nHFOV delivered through nasal prongs is more effective than nCPAP in improving the elimination of CO2.
- Nasal continuous positive airway pressure
- Nasal high-frequency oscillatory ventilation
- Preterm infants
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Pulmonary and Respiratory Medicine