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DOI: 10.1055/a-2118-5351
Reintubation Rate between Nasal High-Frequency Oscillatory Ventilation versus Synchronized Nasal Intermittent Positive Pressure Ventilation in Neonates: A Parallel Randomized Controlled Trial
Funding This study was supported by the Faculty of Medicine, Prince of Songkla University, Thailand (grant number: REC. 62-382-1-1).![](https://www.thieme-connect.de/media/ajp/202411/lookinside/thumbnails/10-1055-a-2118-5351_23apr0248-1.jpg)
Abstract
Objective Nasal high-frequency oscillatory ventilation (nHFOV) and synchronized nasal intermittent positive pressure ventilation (sNIPPV) were the new modes of noninvasive ventilation. This study's aim was to clarify as to which of the nHFOV and sNIPPV modes was superior in preventing postextubation failure or reintubation in neonates.
Study Design An open-label parallel randomized study was performed. Extubated preterm and term neonates were randomly allocated into nHFOV or sNIPPV modes; the reintubation rate was evaluated within 7 days after extubation between the two modes. Subgroup analyses were performed for preterm (gestational age <37 weeks) and very preterm (gestational age <32 weeks) neonates. The sample calculation was 1,050 neonates; however, this trial was stopped early as enrollment was too slow.
Results From July 2020 to June 2022, 202 neonates were assessed for eligibility and 69 neonates were excluded. Finally, 133 neonates were randomly allocated to the study interventions (nHFOV = 67, sNIPPV = 66). The median gestational age and birth weight were 33 (30–37) weeks and 1,910 (1,355–2,836) g, respectively. The reintubation rate within 7 days did not significantly differ between the groups (nHFOV [5/67, 7%] vs. sNIPPV [4/66, 6%]); risk difference [95% confidence interval] = 0.01 [−0.08 to 0.11]; p = 0.99), including preterm (nHFOV [4/55, 7%] vs. sNIPPV [3/44, 7%]) and very preterm (nHFOV [3/25, 12%] vs. sNIPPV [3/25, 12%]) neonates.
Conclusion After neonatal extubation, there was no significant difference of reintubation rates within 7 days between nHFOV and sNIPPV. This trial has been registered in the ClinicalTrials.gov database ( https://clinicaltrials.gov/ct2/show/NCT04323397 ). First posted registration on March 26, 2020.
Key Points
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There was no significant difference of reintubation rates between nHFOV and sNIPPV.
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During nHFOV support, one neonate developed pneumomediastinum.
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During sNIPPV support, one neonate developed pulmonary hemorrhage.
Keywords
airway extubation - high-frequency ventilation - intermittent positive pressure ventilation - newborn - noninvasive ventilation - premature infantNote
This study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving research study participants were approved by the institutional Ethics Committee. Written informed consent was obtained from all participants. This trial has been registered in the ClinicalTrials.gov database ( https://clinicaltrials.gov/ct2/show/NCT04323397 ). First posted registration on March 26, 2020.
Authors' Contributions
M.P. and A.T. designed the data collection instruments, collected data, performed the initial analyses, and drafted the initial manuscript, reviewed, and revised the manuscript. All authors conceptualized and designed the study, coordinated, and supervised data collection; critically reviewed the manuscript for important intellectual content, and approved the final manuscript, as submitted, and agree to be accountable for all aspects of the work.
Publication History
Received: 11 April 2023
Accepted: 26 June 2023
Accepted Manuscript online:
27 June 2023
Article published online:
29 July 2023
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References
- 1 Miller JD, Carlo WA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol 2008; 35 (01) 273-281 , x–xi
- 2 Thatrimontrichai A, Rujeerapaiboon N, Janjindamai W. et al. Outcomes and risk factors of ventilator-associated pneumonia in neonates. World J Pediatr 2017; 13 (04) 328-334
- 3 Thatrimontrichai A, Janjindamai W, Dissaneevate S, Maneenil G, Kritsaneepaiboon S. Risk factors and outcomes of ventilator-associated pneumonia from a neonatal intensive care unit, Thailand. Southeast Asian J Trop Med Public Health 2019; 50: 537-545
- 4 De Luca D, Centorrino R. Nasal high-frequency ventilation. Clin Perinatol 2021; 48 (04) 761-782
- 5 Moretti C, Gizzi C. Synchronized nasal intermittent positive pressure ventilation. Clin Perinatol 2021; 48 (04) 745-759
- 6 Thatrimontrichai A, Sirianansopa K, Janjindamai W, Dissaneevate S, Maneenil G. Comparison of endotracheal reintubation between nasal high-frequency oscillation and continuous positive airway pressure in neonates. Am J Perinatol 2020; 37 (04) 409-414
- 7 Seth S, Saha B, Saha AK, Mukherjee S, Hazra A. Nasal HFOV versus nasal IPPV as a post-extubation respiratory support in preterm infants-a randomised controlled trial. Eur J Pediatr 2021; 180 (10) 3151-3160
- 8 Li Y, Wei Q, Zhao D. et al. Non-invasive high-frequency oscillatory ventilation in preterm infants after extubation: a randomized, controlled trial. J Int Med Res 2021; 49 (02) 300060520984915
- 9 Zhu X, Qi H, Feng Z, Shi Y, De Luca D. ; Nasal Oscillation Post-Extubation (NASONE) Study Group. Noninvasive high-frequency oscillatory ventilation vs nasal continuous positive airway pressure vs nasal intermittent positive pressure ventilation as postextubation support for preterm neonates in China: a randomized clinical trial. JAMA Pediatr 2022; 176 (06) 551-559
- 10 Yuan G, Liu H, Wu Z, Chen X. Evaluation of three non-invasive ventilation modes after extubation in the treatment of preterm infants with severe respiratory distress syndrome. J Perinatol 2022; 42 (09) 1238-1243
- 11 Rüegger CM, Owen LS, Davis PG. Nasal intermittent positive pressure ventilation for neonatal respiratory distress syndrome. Clin Perinatol 2021; 48 (04) 725-744
- 12 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
- 13 Fierson WM. ; American Academy of Pediatrics Section on Ophthalmology; , American Academy of Ophthalmology; , American Association for Pediatric Ophthalmology and Strabismus; , American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2018; 142 (06) 142
- 14 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
- 15 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33 (01) 179-201
- 16 Ferguson KN, Roberts CT, Manley BJ, Davis PG. Interventions to improve rates of successful extubation in preterm infants: a systematic review and meta-analysis. JAMA Pediatr 2017; 171 (02) 165-174
- 17 Chen L, Wang L, Ma J, Feng Z, Li J, Shi Y. Nasal high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome and ARDS after extubation: a randomized controlled trial. Chest 2019; 155 (04) 740-748
- 18 Bradley AY, Peter HG. Mechanical ventilation: disease-specific strategies. In: Keszler M, Suresh GK. eds. Assisted Ventilation of the Neonate. 7th ed. St. Louis, MO: Elsevier; 2022: 288-302
- 19 Moretti C, Giannini L, Fassi C, Gizzi C, Papoff P, Colarizi P. Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: unmasked randomized controlled trial. Pediatr Int 2008; 50 (01) 85-91
- 20 Khalaf MN, Brodsky N, Hurley J, Bhandari V. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics 2001; 108 (01) 13-17
- 21 Friedlich P, Lecart C, Posen R, Ramicone E, Chan L, Ramanathan R. A randomized trial of nasopharyngeal-synchronized intermittent mandatory ventilation versus nasopharyngeal continuous positive airway pressure in very low birth weight infants after extubation. J Perinatol 1999; 19 (6, pt 1): 413-418
- 22 Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics 2001; 107 (04) 638-641
- 23 Gao WW, Tan SZ, Chen YB, Zhang Y, Wang Y. [Randomized trial of nasal synchronized intermittent mandatory ventilation compared with nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome]. Zhongguo Dang Dai Er Ke Za Zhi 2010; 12 (07) 524-526
- 24 Ramaswamy VV, Bandyopadhyay T, Nanda D. et al. Efficacy of noninvasive respiratory support modes as postextubation respiratory support in preterm neonates: a systematic review and network meta-analysis. Pediatr Pulmonol 2020; 55 (11) 2924-2939
- 25 Wang K, Zhou X, Gao S, Li F, Ju R. Noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation for preterm infants as an extubation support: a systematic review and meta-analysis. Pediatr Pulmonol 2023; 58 (03) 704-711
- 26 Kieran EA, Twomey AR, Molloy EJ, Murphy JF, O'Donnell CP. Randomized trial of prongs or mask for nasal continuous positive airway pressure in preterm infants. Pediatrics 2012; 130 (05) e1170-e1176
- 27 Razak A, Patel W. Nasal mask vs binasal prongs for nasal continuous positive airway pressure in preterm infants: a systematic review and meta-analysis. Pediatr Pulmonol 2020; 55 (09) 2261-2271
- 28 Hochwald O, Riskin A, Borenstein-Levin L. et al. Cannula with long and narrow tubing vs short binasal prongs for noninvasive ventilation in preterm infants: noninferiority randomized clinical trial. JAMA Pediatr 2021; 175 (01) 36-43
- 29 Lemyre B, Davis PG, De Paoli AG, Kirpalani H. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev 2017; 2 (02) CD003212
- 30 Kirpalani H, Millar D, Lemyre B, Yoder BA, Chiu A, Roberts RS. ; NIPPV Study Group. A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med 2013; 369 (07) 611-620
- 31 Goel D, Oei JL, Smyth J, Schindler T. Diaphragm-triggered non-invasive respiratory support in preterm infants. Cochrane Database Syst Rev 2020; 3 (03) CD012935