Roberto Bottino1, Federica Pontiggia1, Cinzia Ricci2, Alessandro Gambacorta2, Angela Paladini2, Vladimiras Chijenas3, Arunas Liubsys4, Jurate Navikiene4, Ausrine Pliauckiene4, Domenica Mercadante5, Mariarosa Colnaghi5, Milena Tana2, Chiara Tirone2, Alessandra Lio2, Claudia Aurilia2, Roberta Pastorino6, Velia Purcaro2, Gianfranco Maffei7, Pio Liberatore7, Chiara Consigli8, Cristina Haass8, Gianluca Lista9, Massimo Agosti10, Fabio Mosca5, Giovanni Vento2. 1. Department for the Protection of Women's Health and the Nascent Life, Division of Neonatology, Fondazione Poliambulanza, Brescia, Italy. 2. Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 3. Division of Neonatology, Vilnius Maternity Hospital, Vilnius, Lithuania. 4. Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania. 5. NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. 6. Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore Rome, Rome, Italy. 7. Division of Neonatology, Azienda Ospedaliero, Universitaria Ospedali Riuniti di Foggia, Foggia, Italy. 8. Division of Neonatology, Ospedale San Pietro FBF, Rome, Italy. 9. Department of Pediatrics, NICU, Ospedale dei Bambini V. Buzzi, ASST-FBF-Sacco, Milan, Italy. 10. Division of Neonatology, Ospedale Pilippo del Ponte, Varese, Italy.
Abstract
OBJECTIVE: To compare short-term application of nasal high-frequency oscillatory ventilation (nHFOV) with nasal continuous positive airway pressure (nCPAP). WORKING HYPOTHESIS: nHFOV improves CO2 removal with respect to nCPAP in preterm infants needing noninvasive respiratory support and persistent oxygen supply after the first 72 h of life. STUDY DESIGN: Multicenter non-blinded prospective randomized crossover study. PATIENT SELECTION: Thirty premature infants from eight tertiary neonatal intensive care units, of mean ± SD 26.4 ± 1.8 weeks of gestational age and 921 ± 177 g of birth weight. METHODOLOGY: Infants were randomly allocated in a 1:1 ratio to receive a starting treatment mode of either nCPAP or nHFOV delivered by the ventilator CNO (Medin, Germany), using short binasal prongs of appropriate size. A crossover design with four 1-h treatment periods was used, such that each infant received both treatments twice. The primary outcome was the mean transcutaneous partial pressure of CO2 (TcCO2 ) value during the 2-h cumulative period of nHFOV compared with the 2-h cumulative period of nCPAP. RESULTS: Significantly lower TcCO2 values were observed during nHFOV compared with nCPAP: 47.5 ± 7.6 versus 49.9 ± 7.2 mmHg, respectively, P = 0.0007. A different TcCO2 behavior was found according to the random sequence: in patients starting on nCPAP, TcCO2 significantly decreased from 50.0 ± 8.0 to 46.6 ± 7.5 mmHg during nHFOV (P = 0.001). In patients starting on nHFOV, TcCO2 slightly increased from 48.5 ± 7.8 to 49.9 ± 6.7 mmHg during nCPAP (P = 0.13). CONCLUSIONS:nHFOV delivered through nasal prongs is more effective than nCPAP in improving the elimination of CO2 .
RCT Entities:
OBJECTIVE: To compare short-term application of nasal high-frequency oscillatory ventilation (nHFOV) with nasal continuous positive airway pressure (nCPAP). WORKING HYPOTHESIS: nHFOV improves CO2 removal with respect to nCPAP in preterm infants needing noninvasive respiratory support and persistent oxygen supply after the first 72 h of life. STUDY DESIGN: Multicenter non-blinded prospective randomized crossover study. PATIENT SELECTION: Thirty premature infants from eight tertiary neonatal intensive care units, of mean ± SD 26.4 ± 1.8 weeks of gestational age and 921 ± 177 g of birth weight. METHODOLOGY:Infants were randomly allocated in a 1:1 ratio to receive a starting treatment mode of either nCPAP or nHFOV delivered by the ventilator CNO (Medin, Germany), using short binasal prongs of appropriate size. A crossover design with four 1-h treatment periods was used, such that each infant received both treatments twice. The primary outcome was the mean transcutaneous partial pressure of CO2 (TcCO2 ) value during the 2-h cumulative period of nHFOV compared with the 2-h cumulative period of nCPAP. RESULTS: Significantly lower TcCO2 values were observed during nHFOV compared with nCPAP: 47.5 ± 7.6 versus 49.9 ± 7.2 mmHg, respectively, P = 0.0007. A different TcCO2 behavior was found according to the random sequence: in patients starting on nCPAP, TcCO2 significantly decreased from 50.0 ± 8.0 to 46.6 ± 7.5 mmHg during nHFOV (P = 0.001). In patients starting on nHFOV, TcCO2 slightly increased from 48.5 ± 7.8 to 49.9 ± 6.7 mmHg during nCPAP (P = 0.13). CONCLUSIONS:nHFOV delivered through nasal prongs is more effective than nCPAP in improving the elimination of CO2 .
Authors: Leeann R Pavlek; Brian K Rivera; Charles V Smith; Joanie Randle; Cory Hanlon; Kristi Small; Edward F Bell; Matthew A Rysavy; Sara Conroy; Carl H Backes Journal: J Pediatr Date: 2021-04-21 Impact factor: 6.314