Safety of two ventilator weaning strategies after high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome: a prospective randomized controlled trial
HE Ming-Yuan, LIN Yu-Cong, WU Lin-Lin, SHEN Wei, TANG Li-Xia, ZHU Yao, HUANG Jing, LIN Xin-Zhu
Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, Fujian 361001, China
Abstract：Objective To study the safety of two ventilator weaning strategies after high-frequency oscillatory ventilation (HFOV) for the treatment of neonatal respiratory distress syndrome (NRDS) in preterm infants. Methods A prospective randomized controlled trial was conducted for 101 preterm infants with NRDS, with a gestational age of ≤32+6 weeks or a birth weight of ≤1 500 g, who were admitted to the neonatal intensive care unit of Xiamen Maternal and Child Health Hospital from January 1, 2019 to June 30, 2020. The infants underwent HFOV as the preferred treatment. The infants were randomly divided into an observation group (50 infants with direct weaning from HFOV) and a control group (51 infants with weaning after HFOV was switched to conventional mechanical ventilation). The two groups were compared in terms of failure rate of ventilator weaning within 72 hours, changes in blood gas parameters at 2 hours before weaning and at 2 and 24 hours after weaning, respiratory support therapy, incidence rates of complications, and outcome at discharge. Results There was no significant difference in the failure rate of ventilator weaning within 72 hours (8% vs 14%, P > 0.05). The observation group had a significantly shorter duration of mechanical ventilation than the control group [(64±39) hours vs (88±69) hours, P < 0.05]. There were no significant differences between the two groups in the duration of mechanical ventilation, total oxygen supply time, blood gas parameters before and after ventilator weaning, incidence rates of complications, and outcome at discharge (P > 0.05). Conclusions For preterm infants with NRDS, the strategy of weaning directly from HFOV is safe and reliable and can reduce the duration of invasive mechanical ventilation, and therefore, it holds promise for clinical application.
HE Ming-Yuan,LIN Yu-Cong,WU Lin-Lin et al. Safety of two ventilator weaning strategies after high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome: a prospective randomized controlled trial[J]. CJCP, 2021, 23(1): 18-24.
Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome-2019 update[J]. Neonatology, 2019, 115(4):432-450.
[3]
Schmölzer GM, Kumar M, Pichler G, et al. Non-invasive versus invasive respiratory support in preterm infants at birth:systematic review and meta-analysis[J]. BMJ, 2013, 347:f5980.
[4]
Greenough A, Murthy V, Milner AD, et al. Synchronized mechanical ventilation for respiratory support in newborn infants[J]. Cochrane Database Syst Rev, 2016(8):CD000456.
[5]
Salvo V, Zimmermann LJ, Gavilanes AW, et al. First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis[J]. Pediatr Crit Care Med, 2012, 13(1):72-79.
Yang MC, Hsu JF, Hsiao HF, et al. Use of high frequency oscillatory ventilator in neonates with respiratory failure:the clinical practice in Taiwan and early multimodal outcome prediction[J]. Sci Rep, 2020, 10(1):6603.
Johnson AH, Peacock JL, Greenough A, et al. High-frequency oscillatory ventilation for the prevention of chronic lung disease of prematurity[J]. N Engl J Med, 2002, 347(9):633-642.
[10]
van Velzen A, De Jaegere A, van der Lee J, et al. Feasibility of weaning and direct extubation from open lung high-frequency ventilation in preterm infants[J]. Pediatr Crit Care Med, 2009, 10(1):71-75.
[11]
Tana M, Lio A, Tirone C, et al. Extubation from high-frequency oscillatory ventilation in extremely low birth weight infants:a prospective observational study[J]. BMJ Paediatr Open, 2018, 2(1):e000350.
[12]
Chen L, Wang L, Ma J, et al. Nasal high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome and ARDS after extubation:a randomized controlled trial[J]. Chest, 2019, 155(4):740-748.
[13]
Hansen AR, Eichenwald EC, Stark AR, et al. Cloherty and Stark's Manual of Neonatal Care[M]. 8th. Philadelphia:Lippincott Williams & Wilkins, 2016:401-418.
[14]
Sant'Anna GM, Keszler M. Weaning infants from mechanical ventilation[J]. Clin Perinatol, 2012, 39(3):543-562.
Courtney SE, Durand DJ, Asselin JM, et al. High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants[J]. N Engl J Med, 2002, 347(9):643-652.
[20]
Clark RH, Gerstmann DR, Null DM Jr, et al. Prospective randomized comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome[J]. Pediatrics, 1992, 89(1):5-12.
[21]
Wang SH, Liou JY, Chen CY, et al. Risk factors for extubation failure in extremely low birth weight infants[J]. Pediatr Neonatol, 2017, 58(2):145-150.
[22]
Giaccone A, Jensen E, Davis P, et al. Definitions of extubation success in very premature infants:a systematic review[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(2):F124-F127.
[23]
Gupta D, Greenberg RG, Sharma A, et al. A predictive model for extubation readiness in extremely preterm infants[J]. J Perinatol, 2019, 39(12):1663-1669.
[24]
Escobar V, Soares DS, Kreling J, et al. Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants:a pilot study[J]. BMC Pediatr, 2020, 20(1):241.
[25]
Choi YB, Lee J, Park J, et al. Impact of prolonged mechanical ventilation in very low birth weight infants:results from a national cohort study[J]. J Pediatr, 2018, 194:34-39.e3.
