Nasal HFOV Versus Nasal SIPPV in Neonate Following Extubation: RCT Crossover Study
Condition: High-Frequency Ventilation; Intermittent Positive-Pressure Ventilation; Newborn Morbidity; Noninvasive Ventilation
Study type: Interventional

Summary: 
      Mechanical ventilation was introduced to treat respiratory failure in preterm infants or sick
      neonates then improvements in survival (1,2). However, the complications from short or long
      term use of ventilation can result in unintended harm or burden (e.g., air leak syndrome,
      pneumonia, bronchopulmonary dysplasia, neurological injury, retinopathy of prematurity)
      (3,4). To reduce these risks, clinicians should aggressive extubated neonates as early as
      possible. Respiratory (focus on blood gas as well as partial pressure CO2 [pCO2]) or
      extubation (focus on clinical condition as well as reintubation) failure was worrisome in
      pediatrician and parents if the neonate was reintubated owing to complete recovery of lung
      disease or inadequate respiratory drive.

      Non-invasive ventilation (NIV) was supported for primary respiratory support (initial mode
      before endotracheal intubation) or post-extubation. Nasal continuous positive airway pressure
      (nCPAP) was familiar to NIV mode in neonatal respiratory support. Nowadays, the new NIV
      modalities are nasal intermittent synchronized positive pressure ventilation (nSIPPV) and
      nasal high frequency oscillation (nHFO). To increase the likelihood of nCPAP success, other
      new modalities of NIV may be interesting. From theory, nSIPPV and nHFO combines peak
      inspiratory pressure (PIP) with synchrony and high-frequency oscillations without synchrony
      above CPAP, respectively. From meta-analysis, nSIPPV and nHFO were statistically significant
      superior than nCPAP both respiratory and extubation failure in neonate (5,6).

      The aim of our study was to investigate the efficacy of nHFOV and nSIPPV for CO2 clearance
      and reintubation rate after extubated neonates. The investigators hypothesized that nHFOV
      mode would improve CO2 clearance better than nSIPPV mode.
    

Detailed description: 
      The primary outcome (pCO2) was measured by crossover RCT. The secondary outcome (reintubation
      within 7 days) was measured by paralleled RCT.
    

Intervention name(s): Non-invasive ventilation
Intervention type(s): Device
Intervention description(s): Intervention nasal high frequency oscillatory ventilation (nHFOV) and nasal synchronized intermittent positive pressure ventilation (nSIPPV) were generated by neonatal ventilators (SLE6000 infant ventilators, United Kingdom) using bi-nasal prongs (RAM cannula, NEOTECH®, USA) or the nasal mask of the same type for both ventilation modes. The size of the prongs was determined by the infant's weight. The largest possible prongs were used, with a snug fit to avoid leakage. Pacifier for preterm and term neonate (Jollypop™, USA) was taken to avoid leakage from the mouth. The disposable ventilator circuit (Fisher & Paykel RT268™, Evaqua Dual Limb Infant Breathing Circuit Kit with Evaqua 2 Technology and Pressure Line, Flow > 4L/min, New Zealand) was used. The initial NIV setting was (7) described in arm description. (above)
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Randomized Controlled Crossover Study
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Nasal High-Frequency Oscillation; Nasal Synchronized Intermittent Positive Pressure; Respiratory Failure; Extubation Failure