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Abstract
Noninvasive high-frequency oscillatory (NHFOV) and percussive (NHFPV) ventilation represent 2 nonconventional techniques that may be useful in selected neonatal patients. We offer here a comprehensive review of physiology, mechanics, and biology for both techniques. As NHFOV is the technique with the wider experience, we also provided a meta-analysis of available clinical trials, suggested ventilatory parameters boundaries, and proposed a physiology-based clinical protocol to use NHFOV.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, Paris Saclay University Hospitals, APHP, Paris - France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris - France.
| | - Roberta Centorrino
- Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, Paris Saclay University Hospitals, APHP, Paris - France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris - France
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Wu HL, Lei YQ, Xie WP, Chen Q, Zheng YR. Nasal High-Frequency Oscillatory Ventilation vs. Nasal Continuous Positive Airway Pressure as Therapy for Postextubation Respiratory Failure in Infants After Congenital Heart Surgery. Front Pediatr 2021; 9:700632. [PMID: 34485193 PMCID: PMC8415451 DOI: 10.3389/fped.2021.700632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aimed to evaluate the effects of nasal high-frequency oscillatory ventilation (NHFOV) vs. nasal continuous positive airway pressure (NCPAP) on postextubation respiratory failure (PRF) in infants after congenital heart surgery (CHS). Method: Eighty infants underwent postoperative invasive mechanical ventilation for more than 12 h and planned extubation. The infants were randomized to undergo either NHFOV or NCPAP after extubation. Primary outcomes were the incidence of PRF and reintubation, the average PaCO2 level, the average oxygenation index (OI), and pulmonary recruitment in the early extubation phase. Secondary outcomes included the NCPAP/NHFOV time, length of hospital stay, treatment intolerance, signs of discomfort, pneumothorax, adverse hemodynamic effects, nasal trauma, and mortality. Results: Except for PaCO2 within 12 after extubation (39.3 ± 5.8 vs. 43.6 ± 7.3 mmHg, p = 0.05), there was no statistically significant difference for any of the primary outcome measure (PRF, reintubation within 12 h after extubation, oxygenation index within 12 h after extubation, or lung volumes on X-ray after extubation) or secondary outcome measures (duration of non-invasive ventilation, duration of hospital stay, ventilation intolerance, signs of discomfort, pneumothorax, nasal trauma, adverse hemodynamic effects, or death prior to discharge), p > 0.1 for each comparison. Conclusion: NHFOV therapy after extubation in infants after CHS was more efficient in improving CO2 cleaning than NCPAP therapy, but there was no difference in other outcomes (PRF, reintubation, oxygenation index, and pulmonary recruitment).
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Affiliation(s)
- Hong-Lin Wu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Yu-Qing Lei
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Yi-Rong Zheng
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Centorrino R, Dell'Orto V, Gitto E, Conti G, De Luca D. Mechanics of nasal mask-delivered HFOV in neonates: A physiologic study. Pediatr Pulmonol 2019; 54:1304-1310. [PMID: 31091025 DOI: 10.1002/ppul.24358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/23/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To clarify if nasal mask influences noninvasive high-frequency oscillatory ventilation (NHFOV) mechanics to optimize the clinical use of nasal mask-delivered NHFOV. WORKING HYPOTHESIS Nasal mask may affect the mechanical efficacy of NHFOV. METHODOLOGY We designed a physiologic study composed of an in vitro phase aiming to investigate pressure transmission and volume delivery in a bench model of nasal mask-delivered NHFOV. In a second phase, we measured the leaks in vivo in a series of neonates receiving nasal mask-delivered NHFOV or other forms of noninvasive respiratory support with same nasal masks. RESULTS In vitro pressure transmission is lower with nasal mask (pressure at the lung [Plung]: 2 [0.8]), than with the endotracheal tube (Plung 9.5 [1.5] cmH2 O; P = 0.007). Same applies for volume delivery (Vol: 0.6 [0.2] vs 1.8 [0.5] mL; P = 0.0001). Increasing ventilatory boundaries slowly affects pressure and volume delivery. Ventilating the model with maximal parameters (∆P = 55 cmH2 O; frequency = 8 Hz) we obtained a Vol 1.5 (0.2) mL. The nasal mask provides lower volume delivery and ventilation, compared with nasal prongs studied in previously published studies. Changing frequency allows a better performance than changing ∆P. In vivo leaks are approximately 30% and are similar during NHFOV or other forms of nasal mask-delivered noninvasive ventilation. CONCLUSIONS Nasal mask-delivered NHFOV is feasible, but it may require more aggressive ventilatory parameters to increase volume delivery and ventilation. The use of the nasal mask is associated with some leaks, but this is independent from the type of noninvasive respiratory support applied.
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Affiliation(s)
- Roberta Centorrino
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, South Paris University Hospitals, APHP, Paris, France.,Pediatric and Neonatal Intensive Care Unit, University of Messina, Messina, Italy
| | - Valentina Dell'Orto
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, South Paris University Hospitals, APHP, Paris, France
| | - Eloisa Gitto
- Pediatric and Neonatal Intensive Care Unit, University of Messina, Messina, Italy
| | - Giorgio Conti
- Ventilab, Institute of Anesthesiology and Critical Care, Catholic University of the Sacred Heart, Roma, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, South Paris University Hospitals, APHP, Paris, France.,Ventilab, Institute of Anesthesiology and Critical Care, Catholic University of the Sacred Heart, Roma, Italy.,Physiopathology and Therapeutic Innovation Unit, INSERM U999, South Paris-Saclay University, Paris, France
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Cantin D, Djeddi D, Samson N, Nadeau C, Praud JP. Nasal high-frequency oscillatory ventilation inhibits gastroesophageal reflux in the neonatal period. Respir Physiol Neurobiol 2018; 251:28-33. [PMID: 29438810 DOI: 10.1016/j.resp.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 11/19/2022]
Abstract
Nasal high-frequency oscillatory ventilation (nHFOV) in neonates is increasingly considered due to enhanced alveolar ventilation, absence of patient-ventilator asynchrony and lessened ventilator-induced lung injury. Although any type of non-invasive respiratory support can lead to gastric distension via esophageal air passage and thus promote gastroesophageal refluxes (GERs), we have shown that nasal continuous positive airway pressure (CPAP; 6 cmH2O) and intermittent positive pressure ventilation (15/4 cmH2O) conversely inhibit GERs in lambs. The current objective was to test the hypothesis that nHFOV also inhibits GERs compared to spontaneous ventilation without respiratory support. Eight lambs underwent five hours of polysomnographic and esophageal multichannel intraluminal impedance pHmetry recordings to assess GERs and air passage into the esophagus, with and without nHFOV (mean airway pressure = 8 cmH2O, oscillation frequency = 8 Hz, amplitude ≈ 20 cmH2O and I:E = 1:2). Results revealed that GERs were decreased with nHFOV (p = .03), despite an increase in gas-containing swallows (p = .01). In conclusion, similarly to nasal CPAP and intermittent positive pressure ventilation, nHFOV inhibits GERs in newborn lambs.
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Affiliation(s)
- Danny Cantin
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Physiology, Université de Sherbrooke, QC, Canada
| | - Djamal Djeddi
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Physiology, Université de Sherbrooke, QC, Canada; Department of Pediatrics, Université Picardie Jules Verne, Amiens, France
| | - Nathalie Samson
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Physiology, Université de Sherbrooke, QC, Canada
| | - Charlène Nadeau
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Physiology, Université de Sherbrooke, QC, Canada
| | - Jean-Paul Praud
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Physiology, Université de Sherbrooke, QC, Canada.
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Praud JP, Fortin-Pellerin É. Non-invasive high-frequency oscillatory ventilation for preterm newborns: The time has come for consideration. Pediatr Pulmonol 2017; 52:1526-1528. [PMID: 29064166 DOI: 10.1002/ppul.23784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Jean-Paul Praud
- Divisions of Respiratory Medicine and Neonatology, Department of Pediatrics, University of Sherbrooke, Quebec, Canada
| | - Étienne Fortin-Pellerin
- Divisions of Respiratory Medicine and Neonatology, Department of Pediatrics, University of Sherbrooke, Quebec, Canada
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Ullrich TL, Czernik C, Bührer C, Schmalisch G, Fischer HS. Nasal high-frequency oscillatory ventilation impairs heated humidification: A neonatal bench study. Pediatr Pulmonol 2017; 52:1455-1460. [PMID: 28881101 DOI: 10.1002/ppul.23824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/13/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nasal high-frequency oscillatory ventilation (nHFOV) is a novel mode of non-invasive ventilation used in neonates. However, upper airway obstructions due to viscous secretions have been described as specific adverse effects. We hypothesized that high-frequency oscillations reduce air humidity in the oropharynx, resulting in upper airway desiccation. Therefore, we aimed to investigate the effects of nHFOV ventilatory settings on oropharyngeal gas conditions. METHODS NHFOV or nasal continuous positive airway pressure (nCPAP) was applied, along with heated humidification, to a previously established neonatal bench model that simulates oropharyngeal gas conditions during spontaneous breathing through an open mouth. A digital thermo-hygro sensor measured oropharyngeal temperature (T) and humidity at various nHFOV frequencies (7, 10, 13 Hz), amplitudes (10, 20, 30 cmH2 O), and inspiratory-to-expiratory (I:E) ratios (25:75, 33:66, 50:50), and also during nCPAP. RESULTS Relative humidity was always >99%, but nHFOV resulted in lower mean T and absolute humidity (AH) in comparison to nCPAP (P < 0.001). Specifically, decreasing the nHFOV frequency and increasing nHFOV amplitude caused a decline in T and AH (P < 0.001). Mean T and AH were highest during nCPAP (T 34.8 ± 0.6°C, AH 39.3 ± 1.3 g · m-3 ) and lowest during nHFOV at a frequency of 7 Hz and an amplitude of 30 cmH2 O (T 32.4 ± 0.3°C, AH 34.7 ± 0.5 g · m-3 ). Increasing the I:E ratio also reduced T and AH (P = 0.03). CONCLUSION Intensified nHFOV settings with low frequencies, high amplitudes, and high I:E ratios may place infants at an increased risk of upper airway desiccation. Future studies should investigate strategies to optimize heated humidification during nHFOV.
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Affiliation(s)
- Tim L Ullrich
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Christoph Czernik
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Gerd Schmalisch
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Hendrik S Fischer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
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