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Nasal high‐frequency oscillatory ventilation and CO 2 removal: A randomized controlled crossover trial
Author(s) -
Bottino Roberto,
Pontiggia Federica,
Ricci Cinzia,
Gambacorta Alessandro,
Paladini Angela,
Chijenas Vladimiras,
Liubsys Arunas,
Navikiene Jurate,
Pliauckiene Ausrine,
Mercadante Domenica,
Colnaghi Mariarosa,
Tana Milena,
Tirone Chiara,
Lio Alessandra,
Aurilia Claudia,
Pastorino Roberta,
Purcaro Velia,
Maffei Gianfranco,
Liberatore Pio,
Consigli Chiara,
Haass Cristina,
Lista Gianluca,
Agosti Massimo,
Mosca Fabio,
Vento Giovanni
Publication year - 2018
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24120
Subject(s) - medicine , crossover study , continuous positive airway pressure , gestational age , anesthesia , randomized controlled trial , intensive care , ventilation (architecture) , birth weight , mechanical ventilation , neonatal intensive care unit , mean airway pressure , pediatrics , surgery , pregnancy , intensive care medicine , mechanical engineering , alternative medicine , engineering , pathology , biology , obstructive sleep apnea , genetics , placebo
Objective To compare short‐term application of nasal high‐frequency oscillatory ventilation (nHFOV) with nasal continuous positive airway pressure (nCPAP). Working Hypothesis nHFOV improves CO 2 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 CO 2 (TcCO 2 ) value during the 2‐h cumulative period of nHFOV compared with the 2‐h cumulative period of nCPAP. Results Significantly lower TcCO 2 values were observed during nHFOV compared with nCPAP: 47.5 ± 7.6 versus 49.9 ± 7.2 mmHg, respectively, P = 0.0007. A different TcCO 2 behavior was found according to the random sequence: in patients starting on nCPAP, TcCO 2 significantly decreased from 50.0 ± 8.0 to 46.6 ± 7.5 mmHg during nHFOV ( P = 0.001). In patients starting on nHFOV, TcCO 2 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 CO 2 .