Noninvasive ventilation is an important respiratory management technique for the treatment of mild or moderate respiratory failure in the neonatal intensive care unit. Its reasonable application can effectively avoid the use of invasive ventilation and related complications. Recent studies have found that noninvasive high-frequency oscillatory ventilation has the advantages of both nasal continuous positive airway pressure and high-frequency ventilation and can rapidly improve oxygenation, effectively remove carbon dioxide, and improve respiratory failure. Therefore, it is considered a new and effective noninvasive ventilation mode. There are many studies on the rational use, efficacy, and safety of noninvasive high-frequency oscillatory ventilation in neonates around the world. This article reviews the advances in the clinical studies on noninvasive high-frequency oscillatory ventilation in neonates.
High-Frequency Ventilation ; adverse effects ; Humans ; Infant, Newborn ; Noninvasive Ventilation ; adverse effects ; Respiratory Insufficiency ; therapy

OBJECTIVETo investigate the efficacy of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (nCPAP) in preterm infants aged 26-31(+6) weeks with respiratory distress syndrome after ventilator weaning.

METHODSA total of 161 preterm infants were randomly divided into two groups after ventilator weaning: HHHFNC treatment (n=79) and nCPAP treatment (n=82). The two groups were subdivided into 26-28(+6) weeks and 29-31+6 weeks groups according to the gestational age. The treatment failure rate, reintubation rate within 7 days after extubation, incidence of complications, and mortality during hospitalization were compared between the two groups.

RESULTSThe treatment failure rate and reintubation rate showed no significant differences between the HHHFNC and nCPAP groups. The preterm infants aged 26-28(+6) weeks in the HHHFNC group had a significantly higher treatment failure rate than those in the nCPAP group (P<0.05), while the reintubation rate showed no significant difference. As for the preterm infants aged 29-31(+6) weeks, the treatment failure rate and reintubation rate showed no significant differences between the two groups. The incidence of complications and mortality showed no significant differences between the HHHFNC and nCPAP groups.

CONCLUSIONSIn preterm infants aged 29-31(+6) weeks, HHHFNC has a similar efficacy as nCPAP after ventilator weaning, while in those aged less than 29 weeks, HHHFNC should be used with great caution if selected as the first-line noninvasive respiratory support.

Catheters ; Continuous Positive Airway Pressure ; adverse effects ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Noninvasive Ventilation ; adverse effects ; methods ; Ventilator Weaning

OBJECTIVETo investigate the clinical value of humidified high-flow nasal cannula (HHFNC) as a respiratory support after extubation by comparing it with nasal continuous positive airway pressure (NCPAP) in neonates with meconium aspiration syndrome (MAS) and persistent pulmonary hypertension of the newborn (PPHN).

METHODSA total of 78 neonates with MAS and PPHN were randomly administered with HHFNC or NCPAP immediately after extubation. The following indices were compared between the two groups: blood gas parameters, duration of noninvasive ventilation, rate of extubation failure, and incidence of complications, such as nasal damage, abdominal distension, and intraventricular hemorrhage.

RESULTSThere were no significant differences in the rate of extubation failure, PaO, PCO, and PaO/FiOratio at one hour after NCPAP or HHFNC, duration of noninvasive ventilation, time to full enteral feeding, length of hospital stay, and incidence of intraventricular hemorrhage between the two groups (P>0.05). The HHFNC group had significantly lower incidence of nasal damage (5.0% vs 31.6%; P<0.05) and incidence of abdominal distension (7.5% vs 34.2%; P<0.05) than the NCPAP group.

CONCLUSIONSBoth NCPAP and HHFNC can be used as the sequential therapy for neonates with MSA and PPHN after extubation, and they both have a definite effect. As a new strategy of respiratory support, HHFNC is better tolerated, and has fewer side effects than NCPAP.

Airway Extubation ; adverse effects ; Continuous Positive Airway Pressure ; instrumentation ; methods ; Female ; Humans ; Hypertension, Pulmonary ; therapy ; Infant, Newborn ; Male ; Meconium Aspiration Syndrome ; therapy ; Noninvasive Ventilation ; instrumentation ; methods

BACKGROUND/AIMS: Post-extubation respiratory failure (PERF) is associated with poor clinica l outcomes. High-f low nasa l cannula (HF NC) ox ygen therapy has been used in patients with respiratory failure, but the clinical benefit in patients with PERF remains unclear. The aim of this study was to evaluate the clinical efficacy of HFNC compared to noninvasive ventilation (NIV) in patients with PERF. METHODS: A historic retrospective cohort analysis was performed in 28 beds in the medical Intensive Care Unit (ICU) at a single medical center in South Korea. In total, 73 patients with PERF were enrolled: 39 patients who underwent NIV from April 2007 to March 2009 and 34 patients who received HFNC from April 2009 to May 2011. RESULTS: The rate of avoidance of reintubation was not different between the HFNC group (79.4%) and NIV group (66.7%, p = 0.22). All patients with HFNC tolerated the device, whereas five of those with NIV did not tolerate treatment (p = 0.057). The mean duration of ICU stay was significantly shorter in the HFNC group than in the NIV group (13.4 days vs. 20.6 days, p = 0.015). There was no difference in ICU or in-hospital mortality rate. CONCLUSIONS: HFNC is likely to be as effective as, and better tolerated than, NIV for treatment of PERF.
Administration, Inhalation ; Aged ; Airway Extubation/*adverse effects/mortality ; *Cannula ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Male ; Middle Aged ; *Noninvasive Ventilation/adverse effects ; Oxygen/*administration & dosage ; Oxygen Inhalation Therapy/adverse effects/*instrumentation/mortality ; Republic of Korea ; Respiratory Insufficiency/diagnosis/etiology/mortality/*therapy ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

OBJECTIVETo evaluate the effects of non-invasive ventilation in the treatment of infants with respiratory failure after cardiopulmonary bypass (CPB) and extubation.

METHODSixty-three infants who had undergone successful surgery with CPB, got respiratory failure after extubation. These infants were randomly divided into two groups: non-invasive (NV) group, treated with non-invasive ventilation and invasive (IV) group, treated with tracheal intubation. The alteration of clinical symptoms, heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO₂) and blood gas were measured. A comparison was conducted in the incidence of complication and hospital infection, mechanical ventilation time, length of stay in ICU and hospital stay.

RESULTAmong the 32 patients in NV group, 1 patient died of heart failure, the remaining 31 patients recovered. Of these 32, 26 patients had relief of respiratory failure, the HR 181 (19.7) bpm, RR 54 (16.7) bpm and PaCO₂ 55.5(6) mm Hg decreased to 157 (12) bpm, 35 (3.25) bpm, and 42 (10.5) mm Hg, meanwhile SpO₂ 87% (10.5%), pH 7.29 (0.24), PaO₂ 55.5(6) mm Hg increased to 96% (3%), 7.37(0.15), 82.5 (11) mm Hg after treatment with non-invasive ventilation (P < 0.01). Six patients underwent tracheal intubation because their condition was not improved. Tracheal hemorrhage or laryngeal edema did not occur in these patients. Among the 31 patients in IV group, 1 patient died of heart failure, the other patients were cured. Of these 30, one patient had tracheal hemorrhage and four patients had laryngeal edema. The incidence of hospital infection in NV group was lower compared with that in IV group. The mechanical ventilation time in NV group 42 (17.2) h was shorter compared with that in IV group 50 (20) h (P < 0.01). There was no significant difference in the length of ICU and hospital stay between the two groups.

CONCLUSIONNon-invasive ventilation is a safe and effective method to treat infants with respiratory failure after CPB and extubation.

Airway Extubation ; adverse effects ; Blood Gas Analysis ; Cardiopulmonary Bypass ; adverse effects ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Infant ; Intensive Care Units ; Intubation, Intratracheal ; adverse effects ; Male ; Noninvasive Ventilation ; methods ; Postoperative Period ; Pulmonary Edema ; etiology ; therapy ; Respiratory Insufficiency ; etiology ; therapy ; Respiratory Rate ; Treatment Outcome