Non-invasive high-frequency oscillatory ventilation in preterm infants after extubation: a randomized, controlled trial

Objective To investigate the effectiveness and safety of non-invasive high-frequency oscillatory ventilation (NHFOV) in post-extubation preterm infants. Methods This was a randomized, controlled trial. A total of 149 preterm infants aged between 25 to 34 weeks' gestational age with a birth weight of <1500 g who required invasive mechanical ventilation on admission were included. After extubation, they were randomized to the NHFOV group (n = 47), nasal intermittent positive pressure ventilation (NIPPV) group (n = 51), or nasal continuous positive airway pressure (NCPAP) group (n = 51). We compared the effectiveness and safety among these three groups. Results A total of 139 preterm infants finally completed the study. The reintubation rate was significantly lower in the NHFOV group than in the other groups. The duration of non-invasive ventilation and the length of hospital stay in the NHFOV and NIPPV groups were significantly shorter than those in the NCPAP group. The incidence of bronchopulmonary dysplasia in the NHFOV and NIPPV groups was significantly lower than that in the NCPAP group. The NHFOV group had significantly less nasal injury than the NCPAP group. Conclusion As post-extubation respiratory support in preterm infants, NHFOV has a lower reintubation rate compared with NCPAP and NIPPV, without increasing the rate of complications.

Automated summary

This study compared the effectiveness and safety of non-invasive high-frequency oscillatory ventilation (NHFOV), nasal intermittent positive pressure ventilation (NIPPV), and nasal continuous positive airway pressure (NCPAP) in post-extubation preterm infants. The results showed that NHFOV had a lower reintubation rate, shorter non-invasive ventilation duration and hospital stay, and reduced incidence of bronchopulmonary dysplasia compared to NIPPV and NCPAP. NHFOV also resulted in less nasal injury than NCPAP.