Nasal HFOV Versus Nasal IPPV as a Post Extubation Respiratory Support in Preterm Infants - a Randomised Controlled Trial

Abstract

Early and successful extubation prevents several morbidities in preterm newborns. Several secondary noninvasive respiratory modalities exists but with their merits and demerits. Given the superior respiratory efficacy of nasal high frequency oscillatory ventilation (nHFOV), we tried to examine whether nHFOV could reduce reintubation rates compared to nasal intermittent positive pressure ventilation (NIPPV) during the postextubation phase in preterm infants. Stratified randomisation based on gestational age was done for 86 mechanically ventilated preterm infants between 26 - 37 weeks of gestation within 2 weeks of age, to receive either nHFOV or NIPPV post extubation. The main objective was to compare extubation failure within 72 hours following extubation and secondarily feed intolerance, necrotising enterocolitis (NEC) (> stage 2), hemodynamically significant patent ductus arteriosus (hsPDA), intraventricular haemorrhage (IVH) (> grade 3), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), death, hospital stay duration. No statistical difference was noted for primary outcome ( RR 0.8, 95% CI: 0.23 to 2.78; p = 1.00 ) and secondary outcomes . However nHFOV appeared superior in respect to feed tolerance rates, pCO2 washout and hospital stay duration. Conclusion: Extubation failure within 72 hours in infants less than 37 weeks of gestation did not differ between the two groups. However nHFOV seems promising in reducing enteral feeding issues and hospital stay duration . Larger multicentre studies are required for exploring benefits of nHFOV. Trial registration: www.ctri.nic.in id CTRI/2019/07/020055, registration date July 5, 2019