Role of High frequency oscillatory mode of ventilation (HFOV) as a rescue treatment in newborns with impending respiratory failure after failed conventional mode of ventilation

Abstract

Introduction: High frequency oscillatory ventilation (HFOV) is a new mode of mechanical ventilation which by safer use of mean airway pressure higher than that used during conventional ventilation (CV) is better lung safety strategy in respiratory failure. Aims and Objectives: To study the role of high frequency oscillatory ventilation at a tertiary NICU as rescue mode in neonates with severe respiratory failure. Materials and Methods: 31 neonates admitted in NICU failing conventional mode of ventilation were studied prospectively from January 2014 to September 2015. Babies with respiratory failure failing conventional mode of ventilation were shifted to HFOV. On HFOV, babies were initially started on mean airway pressure 2 cm higher than on conventional ventilation and increased until a saturation of >95% is achieved. Neonates were again weaned off to CV, when target goals of oxygenation and ventilation were reached. Improvements were assessed periodically by arterial blood gas analysis (ABG) and other parameters. Results: 31 neonates were shifted to HFOV as rescue therapy and primary outcome was improvement in oxygenation index and alveolar arterial oxygen radiant (A-aDO2) which were compared and also showed significant impact on secondary outcome of survival. Majority of neonates with primary diagnosis as meconium aspiration syndrome, congenital pneumonia showed 100% recovery. PPHN babies had 78% recovery, while babies with pulmonary haemorrhage had poor outcome. There was statistically significant improvement in oxygenation index and A-aDO2 in 15 babies after shifting to HFOV. Thus, the study shows that HFOV can be used as rescue therapy for neonates after failing conventional ventilation.

Safety use of high frequency oscillatory ventilation in transport of newborn infants affected by severe respiratory failure: preliminary data in central Tuscany

“…In the NETS of the central area of Tuscany this is delivered by the Oscillator Acutronic Fabian HFOi, part of a high-tech neonatal transport unit. Indeed, when other modalities of respiratory support fail [12][13][14], the possibility of transporting a newborn in HFOV is beneficial, being an optimal rescue therapy, for its positive effects on gas exchange. In fact, HFOV is considered a lung protection strategy, because low tidal volume, constant mean airway pressure and high respiratory frequency provide beneficial effects on oxygenation and ventilation, reducing the risk of volotrauma and barotrauma [6].…”

“…Some studies have been carried out on the use of HFOV as an elective mode of ventilation in neonatal respiratory pathology, obtaining good results both in terms of ventilator and hemodynamic parameters [7][8][9][10], but evidence of its effectiveness as a first choice ventilatory method is still poor [11]. HFOV, however, finds greater success as a rescue therapy in infants with severe respiratory distress, not responsive to CMV, due to different pulmonary diseases [7,8,[12][13][14][15][16][17][18][19].…”