The effect of NHFOV on hemodynamics in mild and moderately preterm neonates: a randomized clinical trial

The effect of NHFOV on hemodynamics in mild and moderately preterm neonates: a randomized clinical trial

The aim of this study is to study cardio-respiratory effects of nasal high-frequency oscillatory ventilation (NHFOV) vs. NCPAP as an initial mode of ventilation in moderate-late-preterm infants. A randomized controlled trial was conducted in NICU of Alexandria University Maternity Hospital (AUMH). O...

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Bibliographic Details
Published in:European journal of pediatrics Vol. 183; no. 8; pp. 3263 - 3275
Main Authors: Farag, Marwa Mohamed, Hassan, Mohamed Ahmed Amen, Fasseeh, Nader Abd EL Moneim, Ghazal, Hesham Abd EL Rahim
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2024
Springer Nature B.V
Subjects:
Carbon dioxide
Continuous positive airway pressure
Echocardiography
Female
Heart
Hemodynamics
Hemodynamics - physiology
High-Frequency Ventilation - methods
Humans
Infant, Newborn
Infant, Premature
Infants
Male
Medicine
Medicine & Public Health
Neonates
Newborn babies
Pediatrics
Premature babies
Respiratory distress syndrome
Respiratory Distress Syndrome, Newborn - physiopathology
Respiratory Distress Syndrome, Newborn - therapy
Treatment Outcome
Ventilation
Weaning
SVCF
Functional echocardiography
Non-invasive ventilation
Lung recruitment
NHFOV
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Summary:The aim of this study is to study cardio-respiratory effects of nasal high-frequency oscillatory ventilation (NHFOV) vs. NCPAP as an initial mode of ventilation in moderate-late-preterm infants. A randomized controlled trial was conducted in NICU of Alexandria University Maternity Hospital (AUMH). One-hundred late-moderate-preterm infants were randomly assigned to either NHFOV-group ( n  = 50) or NCPAP-group ( n  = 50). For both groups, functional echocardiography was performed in the first 24 h to detect hemodynamic changes and respiratory outcome was monitored throughout the hospital stay. The main outcomes were hemodynamic measurements and myocardial function using functional echocardiography of those infants along with the respiratory outcome and complications. Kaplan–Meier survival plot was used representing time course of NCPAP and NHFOV failure. Left ventricular output values were not significantly different in both groups with median 202 ml/kg /min and IQR (176–275) in NCPAP-group and 226 ml/kg/min with IQR (181–286) in NHFOV group. Nevertheless, ejection fraction and fractional shortening were significantly higher in NHFOV-group with P 0.001. The time to weaning, the time to reach 30%-FIO2, the need for invasive ventilation, oxygen support duration, and maximal-FIO2 were significantly more in NCAPAP group.      Conclusion : NHFOV is an effective and promising tool of non-invasive-ventilation which can be used as a primary modality of respiratory support in preterm infants with variable forms of respiratory distress syndrome without causing detrimental effect on hemodynamics or significant respiratory complications.      Trial registration : NCT05706428 (registered on January 21, 2023). What is Known: • NHFOV might be beneficial as a secondary mode of ventilation and might have an impact on hemodynamics. What is New: • NHFOV can be used as an initial mode of ventilation with CDP beyond the reported pressure limits of CPAP without causing neither CO2 retention nor adverse hemodynamic consequences.
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Communicated by Daniele De Luca
ISSN:1432-1076
0340-6199
1432-1076
DOI:10.1007/s00431-024-05515-5