Nasal high frequency oscillatory highflow therapy in preterm infants: A randomized crossover trial.

Autor: Thomann J; Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland., Gaertner VD; Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland., Waldmann AD; Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany., Plastina L; Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland., Bassler D; Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland., Rüegger CM; Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland.
Jazyk: angličtina
Zdroj: Pediatric pulmonology [Pediatr Pulmonol] 2024 Feb; Vol. 59 (2), pp. 323-330. Date of Electronic Publication: 2023 Nov 08.
DOI: 10.1002/ppul.26748
Abstrakt: Objectives: To assess the clinical efficacy, safety, and potential physiological mechanisms of highflow therapy with superimposed high frequency oscillations ("osciflow").
Study Design: In this prospective, randomized, single center crossover trial, 30 preterm infants were randomized to receive osciflow or highflow therapy first, each for 180 min. During osciflow, an oscillatory amplitude of 20 mbar and a frequency of 6 Hz were set. The flow rate was 4 L/min during both interventions. Primary outcome was the paired difference in the combined number of desaturations (SpO 2  < 80%) and bradycardia (heart rate <80 beats per min) between interventions. Safety outcomes included nasal trauma, pneumothorax and treatment failure, and a pain score was assessed. In 20 infants, electrical impedance tomography (EIT) recordings were performed to evaluate oscillatory (V Osc ) and tidal volumes (V T ) at the lung level.
Results: Infants with a mean (SD) postnatal age of 33.1 ± 1.2 weeks were included. The median (IQR) number of episodes of desaturation and bradycardia was 19.5 (6-49) during osciflow and 26 (6-44) during highflow therapy (paired difference -2; IQR -10 to 9; p = .37). There were no differences in safety outcomes and pain scores. During osciflow, EIT recordings showed a signal at 6 Hz, which was not detectable during highflow. Corresponding mean (SD) V Osc /V T ratio was 9% (±5%).
Conclusions: In preterm infants, osciflow did not reduce the number of desaturations and bradycardia compared with highflow therapy. Although V Osc were transmitted to the lung during osciflow, their magnitude was small. Osciflow was safe and well tolerated.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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