Weaning of neonates from mechanical ventilation by use of nasopharyngeal high-frequency oscillatory ventilation: a preliminary study

Czernik, Christoph; Schmalisch, Gerd; Bührer, Christoph; Proquitté, Hans

doi:10.3109/14767058.2011.580401

Cited by 53 publications

(56 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The absence of hypocapnia may seem surprising due to the reported ability of nHFOV to decrease CO 2 in newborn infants [6,7,21]. However, administration of nHFOV in these studies was for much longer periods than in our study, and the decrease in PaCO 2 was not apparent in the first 2 h [7].…”

Section: Discussioncontrasting

confidence: 43%

“…Clinical interest in noninvasive HFOV stems from the fact that it does not require synchronization with the patient's breathing efforts [5]. In addition, HFOV is effective in eliminating CO 2 [6,7,21] while inducing less lung injury [3] and ensuring better alveolar development [8]. …”

Section: Discussionmentioning

confidence: 99%

“…For nHFOV, preliminary experiments determined that while regular respiration was present at 8 Hz, respiration was frequently inhibited at 4 Hz. Hence, oscillatory frequency was first set at 8 Hz, mean airway pressure (MAP) at 8 cm H 2 O and inspiratory time at 33% [7,18]. Thereafter, power was progressively increased to obtain three different levels.…”

Section: Methodsmentioning

confidence: 99%

“…Secondly, nHFOV does not require synchronization with the patient's respiratory efforts, a strong advantage in the newborn [5]. Thirdly, case reports in newborns, as well as bench studies using lung models, have shown that nasopharyngeal HFOV is highly effective in eliminating CO 2 [6,7]. Finally, animal data suggest that nasopharyngeal HFOV decreases lung inflammation and improves alveolarization compared to conventional ventilation [8].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Laryngeal Muscle Activity during Nasal High-Frequency Oscillatory Ventilation in Nonsedated Newborn Lambs

et al. 2015

View full text Add to dashboard Cite

Background: We have previously shown that nasal pressure support ventilation (nPSV) can lead to an active inspiratory laryngeal narrowing in lambs. This, in turn, can limit lung ventilation and divert air into the digestive system, with potentially deleterious consequences. On the other hand, nasal high-frequency oscillatory ventilation (nHFOV) is particularly attractive in newborns, especially since, unlike nPSV, it does not require synchronization with the patient's inspiratory efforts. Objectives: The main aim of the present study was to test the hypothesis that glottal constrictor muscle activity (EMG) does not develop during nHFOV. A secondary objective was to study laryngeal EMG during nHFOV-induced central apneas. Methods: Polysomnographic recordings were performed in 7 nonsedated lambs which were ventilated with increasing levels of nPSV and nHFOV at both 4 and 8 Hz, in random order. States of alertness, diaphragm and glottal muscle EMG, SpO₂, and respiratory movements were continuously recorded. Results: While phasic inspiratory glottal constrictor EMG appeared with increasing nPSV levels in 6 out of 7 lambs, it was never observed with nHFOV. In addition, nHFOV at 4 Hz dramatically inhibited central respiratory drive in 4/7 lambs, with 64-100% of recording time spent in central apnea in 3 lambs. No glottal constrictor EMG was observed during these central apneas. Conclusion: nHFOV does not induce glottal constrictor muscle EMG in nonsedated newborn lambs, in contrast to nPSV. This may be an additional advantage of nHFOV relative to nPSV.

show abstract

Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Laryngeal Muscle Activity during Nasal High-Frequency Oscillatory Ventilation in Nonsedated Newborn Lambs

et al. 2015

View full text Add to dashboard Cite

show abstract

“…73 Other observational studies revealed successful use of nHFOV as rescue therapy for nCPAP failure 74 and in the postextubation period. 75 To explore the future role that nHFOV could play in the treatment of RDS, further research on effectiveness and safety is needed.If rescue surfactant is administered without endotracheal intubation for more severe RDS, its benefits could possibly be combined with those of noninvasive respiratory support. Surfactant can be administered via a thin endotracheal catheter placed intratracheally by using a laryngoscope and a Magill forceps during spontaneous breathing and ongoing nCPAP treatment.…”

mentioning

confidence: 99%

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

2013

Self Cite

View full text Add to dashboard Cite

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis abstract BACKGROUND AND OBJECTIVE: Mechanical ventilation via an endotra-cheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants ,30 weeks' gestational age (GA). METHODS: In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants ,30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6. RESULTS: We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage.

show abstract

Non-invasive high-frequency ventilation in newborn infants with respiratory distress

Abdel-Latif,

Tan,

Fiander

et al. 2024

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background Respiratory distress occurs in up to 7% of newborns, with respiratory support (RS) provided invasively via an endotracheal (ET) tube or non‐invasively via a nasal interface. Invasive ventilation increases the risk of lung injury and chronic lung disease (CLD). Using non‐invasive strategies, with or without minimally invasive surfactant, may reduce the need for mechanical ventilation and the risk of lung damage in newborn infants with respiratory distress. Objectives To evaluate the benefits and harms of nasal high‐frequency ventilation (nHFV) compared to invasive ventilation via an ET tube or other non‐invasive ventilation methods on morbidity and mortality in preterm and term infants with or at risk of respiratory distress. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL and three trial registries in April 2023. Selection criteria Randomised controlled trials (RCTs), cluster‐ or quasi‐RCTs of nHFV in newborn infants with respiratory distress compared to invasive or non‐invasive ventilation. Data collection and analysis Two authors independently selected the trials for inclusion, extracted data, assessed the risk of bias, and undertook GRADE assessment. Main results We identified 33 studies, mostly in low‐ to middle‐income settings, that investigated this therapy in 5068 preterm and 46 term infants. nHFV compared to invasive respiratory therapy for initial RS We are very uncertain whether nHFV reduces mortality before hospital discharge (RR 0.67, 95% CI 0.20 to 2.18; 1 study, 80 infants) or the incidence of CLD (RR 0.38, 95% CI 0.09 to 1.59; 2 studies, 180 infants), both very low‐certainty. ET intubation, death or CLD, severe intraventricular haemorrhage (IVH) and neurodevelopmental disability (ND) were not reported. nHFV vs nasal continuous positive airway pressure (nCPAP) used for initial RS We are very uncertain whether nHFV reduces mortality before hospital discharge (RR 1.00, 95% CI 0.41 to 2.41; 4 studies, 531 infants; very low‐certainty). nHFV may reduce ET intubation (RR 0.52, 95% CI 0.33 to 0.82; 5 studies, 571 infants), but there may be little or no difference in CLD (RR 1.35, 95% CI 0.80 to 2.27; 4 studies, 481 infants); death or CLD (RR 2.50, 95% CI 0.52 to 12.01; 1 study, 68 participants); or severe IVH (RR 1.17, 95% CI 0.36 to 3.78; 4 studies, 531 infants), all low‐certainty evidence. ND was not reported. nHFV vs nasal intermittent positive‐pressure ventilation (nIPPV) used for initial RS nHFV may result in little to no difference in mortality before hospital discharge (RR 1.86, 95% CI 0.90 to 3.83; 2 studies, 84 infants; low‐certainty). nHFV may have little or no effect in reducing ET intubation (RR 1.33, 95% CI 0.76 to 2.34; 5 studies, 228 infants; low‐certainty). There may be a reduction in CLD (...

show abstract

Weaning of neonates from mechanical ventilation by use of nasopharyngeal high-frequency oscillatory ventilation: a preliminary study

Abstract: This small observational study demonstrates that nHFOV can be successfully applied to wean premature infants from ventilator support.

Cited by 53 publications

References 29 publications

Laryngeal Muscle Activity during Nasal High-Frequency Oscillatory Ventilation in Nonsedated Newborn Lambs

Laryngeal Muscle Activity during Nasal High-Frequency Oscillatory Ventilation in Nonsedated Newborn Lambs

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

Non-invasive high-frequency ventilation in newborn infants with respiratory distress

Contact Info

Product

Resources

About