Non-invasive high-frequency oscillatory ventilation versus non-invasive intermittent mandatory ventilation as a rescue mode in preterm infants with respiratory distress on nasal CPAP-a randomized control trial.

Abstract

To compare NHFOV in decreasing the need for mechanical ventilation in the first 7 days of randomization in preterm infants born before 34 weeks of gestational age having nCPAP failure when used as rescue mode compared to NIMV. All eligible neonates were randomized and allocated to either NHFOV or NIMV group after taking the consent from the parents. Standardized protocol was followed on initiation, titration, weaning, and optimization of all the respiratory supports. In this study, a total of 45 neonates were eligible; among them, 20 neonates were randomized to NIMV group and 20 neonates to NHFOV group remaining 5 infants were missed due to the non-availability of a machine (n = 4) and missed randomization (n = 1). The primary outcome was need for mechanical ventilation within first 7 days of randomization in NIMV and NHFOV group was 45% and 40% (p = 0.85, OR = 1.22 (CI 0.35-4.3)). The secondary outcome was a duration of ventilation within 72 h of randomization was 40% vs. 31.6% in NIMV and NHFOV group (p = 0.58). Bronchopulmonary dysplasia was 5% and 10% in NIMV and NHFOV group with p = 0.548, OR = 0.47 (CI 0.39-5.6), and mortality was one infant in NIMV and 3 infants in NHFOV group (p = 0.568, OR = 0.29 (CI 0.02-3.1)).

Conclusion: NIMV and NHFOV are comparable in reducing the rates of mechanical ventilation within 72 h and within 7 days of post-randomization. Multi-centric trials with large sample sizes are required to prove the hypothesis.

Trial registration: www.ctri.nic.in id CTRI/2021/10/037681, registered on October 29, 2021.

What is known: • NIMV or nHFOV being used as primary as well as post extubation respiratory support in neonates. • NIMV and nHFOV has shown better clinical outcomes than nCPAP when used as primary and post extubation respiratory support.

What is new: • NIMV and nHFOV can be used as rescue mode after CPAP failure to prevent need for mechanical ventilation. • nHFOV appears promising as rescue mode in neonates who meets CPAP failure criteria.