Nasal high-frequency oscillatory ventilation and CO2 removal: A randomized controlled crossover trial

Giovanni Vento, Alessandro Gambacorta, Angela Paladini, Roberta Pastorino, Velia Purcaro, Roberto Bottino, Federica Pontiggia, Vladimiras Chijenas, Arunas Liubsys, Jurate Navikiene, Ausrine Pliauckiene, Domenica Mercadante, Mariarosa Colnaghi, Gianfranco Maffei, Pio Liberatore, Chiara Consigli, Cristina Haass, Gianluca Lista, Massimo Agosti, Fabio Mosca

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

17 Citazioni (Scopus)

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.
Lingua originaleEnglish
pagine (da-a)1245-1251
Numero di pagine7
RivistaPediatric Pulmonology
Volume53
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Pediatrics, Perinatology and Child Health
  • Pulmonary and Respiratory Medicine
  • nasal continuous positive airway pressure
  • nasal high-frequency oscillatory ventilation
  • preterm infants

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