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Non-invasive high-frequency ventilation versus bi-phasic continuous positive airway pressure (BP-CPAP) following CPAP failure in infants <1250 g: a pilot randomized controlled trial

Journal of Perinatology volume 37, pages 49–53 (2017)Cite this article

Subjects

Abstract

Objective:

Non-invasive high-frequency ventilation (NIHFV), a relatively new modality, is gaining popularity despite limited data. We sought to evaluate the effectiveness of NIHFV versus bi-phasic continuous positive airway pressure (BP-CPAP) in preterm infants failing CPAP.

Study Design:

Infants with BW<1250 g on CPAP were randomly assigned to NIHFV or BP-CPAP if they met pre-determined criteria for CPAP failure. Infants were eligible for randomization after 72 h age and until 2000 g. Guidelines for adjustment of settings and criteria for failure of assigned mode were implemented. The primary aim was to assess feasibility of a larger trial. In addition, failure of assigned non-invasive respiratory support (NRS) mode, invasive mechanical ventilation (MV) 72 h and 7 days post-randomization, and bronchopulmonary dysplasia (BPD) were assessed.

Results:

Thirty-nine infants were randomized to NIHFV (N=16) or BP-CPAP (N=23). There were no significant differences in mean (s.d.) postmenstrual age (28.6 (1.5) versus 29.0 (2.3) weeks, P=0.47), mean (s.d.) weight at randomization (965.0 (227.0) versus 958.1 (310.4) g, P=0.94) or other baseline demographics between the groups. Failure of assigned NRS mode was lower with NIHFV (37.5 versus 65.2%, P=0.09), although not statistically significant. There were no differences in rates of invasive MV 72 h and 7 days post-randomization or BPD.

Conclusion:

NIHFV was not superior to BP-CPAP in this pilot study. Effectiveness of NIHFV needs to be proven in larger multi-center, appropriately powered trials before widespread implementation.

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References

  1. Donn SM, Sinha SK . Minimising ventilator induced lung injury in preterm infants. Arch Dis Child Fetal Neonatal Ed 2006; 91 (3): F226–F230.

    Article  CAS  Google Scholar 

  2. Hart SM, McNair M, Gamsu HR, Price JF . Pulmonary interstitial emphysema in very low birthweight infants. Arch Dis Child 1983; 58 (8): 612–615.

    Article  CAS  Google Scholar 

  3. Fan E, Villar J, Slutsky AS . Novel approaches to minimize ventilator-induced lung injury. BMC Med 2013; 11: 85.

    Article  Google Scholar 

  4. Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF . Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA 2003; 289 (9): 1124–1129.

    Article  Google Scholar 

  5. Owen LS, Morley CJ, Davis PG . Neonatal nasal intermittent positive pressure ventilation: a survey of practice in England. Arch Dis Child Fetal Neonatal Ed 2008; 93 (2): F148–F150.

    Article  CAS  Google Scholar 

  6. Mahmoud RA, Roehr CC, Schmalisch G . Current methods of non-invasive ventilatory support for neonates. Paediatr Respir Rev 2011; 12 (3): 196–205.

    Article  Google Scholar 

  7. Roberts CT, Davis PG, Owen LS . Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013? Neonatology 2013; 104 (3): 203–209.

    Article  CAS  Google Scholar 

  8. Shah PS, Sankaran K, Aziz K, Allen AC, Seshia M, Ohlsson A et al. Canadian Neonatal Network. Outcomes of preterm infants &lt;29 weeks gestation over 10-year period in Canada: a cause for concern? J Perinatol 2012; 32 (2): 132–138.

    Article  CAS  Google Scholar 

  9. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S . Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. JAMA 2015; 314 (10): 1039–1051.

    Article  CAS  Google Scholar 

  10. Chang HK, Harf A . High-frequency ventilation: a review. Respir Physiol 1984; 57 (2): 135–152.

    Article  CAS  Google Scholar 

  11. Pillow JJ . High-frequency oscillatory ventilation: mechanisms of gas exchange and lung mechanics. Crit Care Med 2005; 33 (3 Suppl): S135–S141.

    Article  Google Scholar 

  12. Mukerji A, Singh B, Helou SE, Fusch C, Dunn M, Belik J et al. Use of noninvasive high-frequency ventilation in the neonatal intensive care unit: a retrospective review. Am J Perinatol 2015; 30 (2): 171–176.

    Article  Google Scholar 

  13. Colaizy TT, Younis UM, Bell EF, Klein JM . Nasal high-frequency ventilation for premature infants. Acta Paediatr 2008; 97 (11): 1518–1522.

    Article  Google Scholar 

  14. Dumas, De La Roque E, Bertrand C, Tandonnet O, Rebola M, Roquand E et al. Nasal high frequency percussive ventilation versus nasal continuous positive airway pressure in transient tachypnea of the newborn: a pilot randomized controlled trial (NCT00556738). Pediatr Pulmonol 2011; 46 (3): 218–223.

    Article  Google Scholar 

  15. van der Hoeven M, Brouwer E, Blanco CE . Nasal high frequency ventilation in neonates with moderate respiratory insufficiency. Arch Dis Child Fetal Neonatal Ed 1998; 79 (1): F61–F63.

    Article  CAS  Google Scholar 

  16. Schulz KF, Altman DG, Moher D . CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 2010; 63 (8): 834–840.

    Article  Google Scholar 

  17. Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4): 529–534.

    Article  CAS  Google Scholar 

  18. Kugelman A, Durand M . A comprehensive approach to the prevention of bronchopulmonary dysplasia. Pediatr Pulmonol 2011; 46 (12): 1153–1165.

    Article  Google Scholar 

  19. De Luca D, Carnielli VP, Conti G, Piastra M . Noninvasive high frequency oscillatory ventilation through nasal prongs: bench evaluation of efficacy and mechanics. Intensive Care Med 2010; 36 (12): 2094–2100.

    Article  Google Scholar 

  20. De Luca D, Piastra M, Pietrini D, Conti G . Effect of amplitude and inspiratory time in a bench model of non-invasive HFOV through nasal prongs. Pediatr Pulmonol 2012; 47 (10): 1012–1018.

    Article  Google Scholar 

  21. Mukerji A, Finelli M, Belik J . Nasal high-frequency oscillation for lung carbon dioxide clearance in the newborn. Neonatology 2013; 103 (3): 161–165.

    Article  CAS  Google Scholar 

  22. Null DM, Alvord J, Leavitt W, Wint A, Dahl MJ, Presson AP et al. High-frequency nasal ventilation for 21 d maintains gas exchange with lower respiratory pressures and promotes alveolarization in preterm lambs. Pediatr Res 2014; 75 (4): 507–516.

    Article  Google Scholar 

  23. Rehan VK, Fong J, Lee R, Sakurai R, Wang ZM, Dahl MJ et al. Mechanism of reduced lung injury by high-frequency nasal ventilation in a preterm lamb model of neonatal chronic lung disease. Pediatr Res 2011; 70 (5): 462–466.

    Article  Google Scholar 

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Acknowledgements

We acknowledge NICU registered respiratory therapists at Mount Sinai Hospital, Toronto, Canada for assistance with recruitment and randomization. Sources of funding/grants from Sandra Schmirler Foundation. Clinicaltrials.gov ID: NCT02051491.

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Authors and Affiliations

  1. Department of Paediatrics, McMaster University, Hamilton, ON, Canada

    A Mukerji

  2. Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada

    K Sarmiento, B Lee & K Hassall

  3. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    V Shah

Authors
  1. A Mukerji
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  2. K Sarmiento
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  3. B Lee
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  4. K Hassall
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  5. V Shah
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Corresponding author

Correspondence to A Mukerji.

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The authors declare no conflict of interest.

Additional information

Data from this study were presented at Pediatric Academic Societies 2015.

Supplementary Information accompanies the paper on the Journal of Perinatology website .

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Mukerji, A., Sarmiento, K., Lee, B. et al. Non-invasive high-frequency ventilation versus bi-phasic continuous positive airway pressure (BP-CPAP) following CPAP failure in infants <1250 g: a pilot randomized controlled trial. J Perinatol 37, 49–53 (2017). https://doi.org/10.1038/jp.2016.172

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