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Response to ‘Non-invasive high frequency ventilation and the errors from the past: designing simple trials neglecting complex respiratory physiology’

Journal of Perinatology volume 37, page 1067 (2017)Cite this article

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We would like to thank Dr De Luca for his insightful comments in a letter to the editor published in this issue of the Journal on our study on noninvasive high-frequency ventilation (NIHFV) in neonates.1 This was the first research of its kind evaluating a relatively new modality in the context of a pilot randomized controlled trial. While some clinical outcomes were ascertained, the primary objective of the study was to determine the feasibility of conducting a larger study, and take lessons learned towards the design and implementation of such a definitive trial. In that spirit, we feel that discourse and dialogue is imperative in ensuring that future trials on this subject are set up for success, and yield specific yet generalizable results.

Several important points have been raised in the letter by Dr De Luca, the first of which relates to the possible heterogeneity in the randomized subjects with regards to their lung disease. Use of clinical noninvasive bedside techniques has been suggested. While some techniques (such as transcutaneous blood gas monitoring) are relatively commonplace in the clinical setting, others (such as lung ultrasound and electrical impedance tomography) are not. As a pragmatic pilot trial, the intent was to capture instances where advancement from continuous positive airway pressure (CPAP) was to occur regardless of underlying lung pathology. Therefore, while we agree that mechanisms in place to decipher underlying lung disease would be helpful, lack of widespread use of some of these strategies may limit their utility presently.

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References

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    A Mukerji

  2. Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    V Shah

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  1. A Mukerji
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  2. V Shah
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Correspondence to A Mukerji.

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Mukerji, A., Shah, V. Response to ‘Non-invasive high frequency ventilation and the errors from the past: designing simple trials neglecting complex respiratory physiology’. J Perinatol 37, 1067 (2017). https://doi.org/10.1038/jp.2017.79

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