Noninvasive High-Frequency Oscillatory Ventilation: A Retrospective Chart Review

Abstract

Objective: This study aimed to review the feasibility of nasal high-frequency oscillatory ventilation (NHFOV) in preventing reintubation in preterm infants.

Study design: This is a retrospective cohort study of all premature newborn infants placed on NHFOV in a single-center neonatal intensive care unit.

Results: Twenty-seven patients (birth weight: 765 ± 186 g, gestational age: 28 ± 2 weeks) were commenced on NHFOV on 32 occasions. NHFOV was used immediately postextubation as the primary mode of noninvasive ventilation (NIV; prophylaxis) in 10 of 32 occasions and as "rescue" (failure of NCPAP or biphasic CPAP) in 22 of 32 occasions. Treatment with NHFOV was successful in 22 occasions (69%) while on 10 occasions (31%) reintubation was required within 72 hours. In the rescue group, there was significant reduction in the mean (standard deviation [SD]) number of apneas (0.9 ± 1.07 vs. 0.3 ± 0.29, p < 0.005), but there were no significant changes in the PCO₂ level (52 [ ± 9.8] vs. 52 [ ± 8.6] mm Hg, p = 0.8), or the FiO₂ requirement (0.39 ± 0.19 vs. 0.33 ± 0.10, p = 0.055) before and after commencing NHFOV, respectively.

Conclusion: The use of NHFOV is feasible as a prophylactic or rescue mode of NIV following extubation and was associated with decrease in the number of apneas without significant changes in PCO₂ or oxygen requirements. A well-designed randomized control trial is needed to determine the indications, clinical outcomes, and safety of this treatment modality.

Key points: · NHFOV is a new and evolving mode of noninvasive ventilation.. · The use of NHFOV is feasible as a prophylactic or rescue mode of noninvasive ventilation.. · A well-designed randomized control is needed to evaluate the efficacy and safety of NHFOV safe..