Nasal high-frequency oscillation ventilation in neonates: a survey in five European countries

Fischer, Hendrik; Bohlin, Kajsa; Bührer, Christoph; Schmalisch, Gerd; Cremer, Malte; Reiss, Irwin K M; Czernik, Christoph

doi:10.1007/s00431-014-2419-y

Cited by 83 publications

(88 citation statements)

References 34 publications

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“…Several modern neonatal ventilators are technically able to provide NHFOV, although their performance may be variable at extreme settings or for term neonates 8 9. A recent European survey described wide variation in the type of device used to provide NHFOV 5. A new concept has also been recently introduced, as bench experiments demonstrated the feasibility of generating NHFOV through the control of fan and valve: this allows designing a ventilator specifically dedicated only to NHFOV 10…”

Section: Basic Principles Of Nhfovmentioning

confidence: 99%

“…Regarding the effects linked to a non-invasive interface, it is conceivable that having an oscillating interface on the skin could produce some local reactions or skin injuries, but this has never been studied, and a European survey has not described skin injuries among the side effects of NHFOV 5. Early HFOV has been claimed to be less pro-inflammatory than conventional ventilation34 and one could imagine the same effect for NHFOV as compared with conventional NIV.…”

Section: Biological Effects Of Nhfovmentioning

confidence: 99%

“…Thus, it is not possible to draw conclusions about the clinical efficacy of NHFOV regarding its effect on CO 2 elimination, although this latter is otherwise well established 18 35 36 38 39. Until now, 111 babies have been described in clinical studies (table 1), although many more are likely to receive this type of respiratory support during daily care 5 6…”

Section: Clinical Studies Of Nhfovmentioning

confidence: 99%

“…However, given its simplicity, the use of NHFOV has increased and it is now quite often used in daily neonatal intensive care unit care, especially in Europe5 and Canada,6 even though no clear evidence exists about its clinical usefulness. The aims of this paper are to review the physiology and biological effects of NHFOV, to present the current clinical evidence on its use, to provide some guiding principles to clinicians and to suggest directions of further enquiry in this area.…”

Section: Introductionmentioning

confidence: 99%

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Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data

Luca

Dell’Orto

2016

Arch Dis Child Fetal Neonatal Ed

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Non-invasive high-frequency oscillatory ventilation (NHFOV) consists of the application of a bias flow generating a continuous distending positive pressure with superimposed oscillations, which have constant frequency and active expiratory phase. NHFOV matches together the advantages of high-frequency ventilation (no need for synchronisation, high efficacy in removing CO 2 ) and nasal continuous positive airway pressure (CPAP) (non-invasive interface, increase in functional residual capacity allowing oxygenation to improve). There is enough clinical expertise demonstrating that NHFOV may be tried in some selected cases, in whom CPAP or conventional non-invasive ventilation have failed. Nonetheless, there are no clear data about its clinical usefulness and there is a need for randomised controlled studies. Our purpose is to review the physiology and biological effects of NHFOV, to present the current clinical evidence on its use, to provide some guiding principles to clinicians and suggest directions for further research.

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Section: Basic Principles Of Nhfovmentioning

confidence: 99%

Section: Biological Effects Of Nhfovmentioning

confidence: 99%

Section: Clinical Studies Of Nhfovmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data

Luca

Dell’Orto

2016

Arch Dis Child Fetal Neonatal Ed

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“…A recent European survey reported that 17% were using noninvasive HFOV for diverse indications, mainly for CPAP failure or as primary therapy. There were significant variations in the types of equipment, interfaces and settings used for its delivery, with little information about its safety profile [33]. Similarly, noninvasive NAVA is increasingly applied in many NICUs across North America using evidence mainly based from animal data, retrospective clinical studies and case series [34].…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

Respiratory Care Protocols in Neonatal Intensive Care

Shalish¹,

Anna²

2016

Respiratory Management of Newborns

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Neonatal respiratory care involves physicians with variable backgrounds treating multiple respiratory problems and populations with a number of invasive and noninvasive devices and strategies. Unfortunately, there is a lack of strong evidence to guide the most adequate management for several specific situations. Altogether, this complexity leads to significant practice variability that can affect patient and health care outcomes. Respiratory care protocols, guided by evidence and/or consensus, are an attractive solution to promote standardization of care and reduction of unnecessary practice variations. Indeed, despite the limited evidence supporting the use of respiratory protocols in neonates, a significant number of units have already developed and implemented them into clinical practice. Respiratory care protocols appear to promote evidence-based practices, discourage outdated approaches and ultimately improve patient safety.

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Noninvasive High-Frequency Oscillatory Ventilation vs Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation as Postextubation Support for Preterm Neonates in China

Zhu

Feng

et al. 2022

JAMA Pediatr

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for the Nasal Oscillation Post-Extubation (NASONE) Study Group IMPORTANCE Several respiratory support techniques are available to minimize the use of invasive mechanical ventilation (IMV) in preterm neonates. It is unknown whether noninvasive high-frequency oscillatory ventilation (NHFOV) is more efficacious than nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) in preterm neonates after their first extubation.OBJECTIVE To test the hypothesis that NHFOV is more efficacious than NCPAP or NIPPV in reducing IMV after extubation and until neonatal intensive care unit discharge among preterm neonates. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, pathophysiology-based, assessor-blinded, 3-group, randomized clinical trial was conducted in 69 tertiary referral neonatal intensive care units in China, recruiting participants from December 1, 2017, to May 31, 2021. Preterm neonates who were between the gestational age of 25 weeks plus 0 days and 32 weeks plus 6 days and were ready to be extubated were randomized to receive NCPAP, NIPPV or NHFOV. Data were analyzed on an intention-to-treat basis. INTERVENTIONSThe NCPAP, NIPPV, or NHFOV treatment was initiated after the first extubation and lasted until discharge.MAIN OUTCOMES AND MEASURES Primary outcomes were total duration of IMV, need for reintubation, and ventilator-free days. These outcomes were chosen to describe the effect of noninvasive ventilation strategy on the general need for IMV.RESULTS A total of 1440 neonates (mean [SD] age at birth, 29.4 [1.8] weeks; 860 boys [59.7%]) were included in the trial. Duration of IMV was longer in NIPPV (mean difference, 1.2; 95% CI, 0.01-2.3 days; P = .04) and NCPAP (mean difference, 1.5 days; 95% CI, 0.3-2.7 days; P = .01) compared with NHFOV. Neonates who were treated with NCPAP needed reintubations more often than those who were treated with NIPPV (risk difference: 8.1%; 95% CI, 2.9%-13.3%; P = .003) and NHFOV (risk difference, 12.5%; 95% CI, 7.5%-17.4%; P < .001). There were fewer ventilator-free days in neonates treated with NCPAP than in those treated with NIPPV (median [25th-75th percentile] difference, −3 [−6 to −1] days; P = .01). There were no differences between secondary efficacy or safety outcomes, except for the use of postnatal corticosteroids (lower in NHFOV than in NCPAP group; risk difference, 7.3%; 95% CI, 2.6%-12%; P = .002), weekly weight gain (higher in NHFOV than in NCPAP group; mean difference, −0.9 g/d; 95% CI, −1.8 to 0 g/d; P = .04), and duration of study intervention (shorter in NHFOV than in NIPPV group; median [25th-75th percentile] difference, −1 [−3 to 0] days; P = .01).CONCLUSIONS AND RELEVANCE Results of this trial indicated that NHFOV, if used after extubation and until discharge, slightly reduced the duration of IMV in preterm neonates, and both NHFOV and NIPPV resulted in a lower risk of reintubation than NCPAP. All 3 respiratory support techniques were equally safe for this patient population.

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Nasal high-frequency oscillation ventilation in neonates: a survey in five European countries

Abstract: In a number of European NICUs, clinicians use nHFOV. The present survey identified differences in nHFOV equipment, indications, and settings. Controlled clinical trials are needed to investigate the efficacy and side effects of nHFOV in neonates.

Cited by 83 publications

References 34 publications

Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data

Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data

Respiratory Care Protocols in Neonatal Intensive Care

Noninvasive High-Frequency Oscillatory Ventilation vs Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation as Postextubation Support for Preterm Neonates in China

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