Nasal high‐frequency percussive ventilation vs nasal continuous positive airway pressure in newborn infants respiratory distress: A cross over clinical trial

Abstract

Objective To determine if nasal high‐frequency percussive ventilation (nHFPV) to manage neonatal respiratory distress decreases the regional cerebral oxygen saturation (rScO2) compared to nasal continous positive airway pressure (nCPAP). Study Design A prospective, randomized, monocentric, open‐label, noninferiority crossover trial. Newborns of gestational age (GA) ≥ 33 weeks exhibiting persistent respiratory distress after 10 minutes of life were treated with nHFPV and nCPAP, in succession and in random order. The primary endpoint was the mean rScO2, as revealed by near‐infrared spectroscopy (NIRS). Results Forty‐nine newborns were randomized; the mean GA and birth weight was 36.4 ± 1.9 weeks and 2718 ± 497 g. The mean rScO2 difference during the last 5 minutes of each ventilation mode (nHFPV minus nCPAP) was –0.7 ± 5.4% (95% confidence interval (CI) –2.25; 0.95%). Conclusion In our study on newborns of GA ≥33 weeks treated for respiratory distress, cerebral oxygenation via nHFPV was not inferior to nCPAP.

Mechanical Ventilation in Pediatric and Neonatal Patients

“…Only small case series exist in neonates ventilated with HFPV ( Pfenninger and Gerber, 1987 ; Pfenninger and Minder, 1988 ; Paviotti et al, 2014 ), but have demonstrated improvements in oxygenation without increasing airway pressures ( Pfenninger and Gerber, 1987 ; Paviotti et al, 2014 ), and improved static compliance ( Pfenninger and Minder, 1988 ). Nasal high-frequency percussive ventilation has recently been popularized ( De La Roque et al, 2011 ; Moresco et al, 2020 ; Renesme et al, 2020 ) and compared with nasal continuous positive airway pressure, demonstrated non-inferiority ( Renesme et al, 2013 ), possible benefit, and that it is well-tolerated ( De La Roque et al, 2011 ). In a piglet model of meconium aspiration syndrome, HFPV and CV were associated with lower mean airway pressures and OI as compared with HFOV, but there was no apparent difference in histologic lung injury ( Renesme et al, 2013 ).…”