Weaning of neonates from mechanical ventilation by use of nasopharyngeal high-frequency oscillatory ventilation: a preliminary study

Abstract

Objective. To investigate the feasibility of nasopharyngeal high-frequency oscillatory ventilation (nHFOV) immediately after extubation in difficult-to-wean preterm infants.

Study design. This was an observational study of 20 mechanically ventilated neonates [median (range) birth weight 635 (382–1020)g, median gestational age 25.3 (23.7–27.6) weeks] at high risk for extubation failure. Nine infants had failed at least one previous extubation. Fourteen infants were given hydrocortisone. All 20 infants were extubated into nHFOV, with a mean airway pressure of 8 cmH₂O, an amplitude of 20 cmH₂O, and a frequency of 10 Hz.

Results. Infants remained on nHFOV for a median duration of 136.5 (7.0–456.0) h until further weaning to continuous positive airway pressure (n =14) or reintubation (n = 6). Reintubation was performed in 1 of 11 infants who had not experienced any previous extubation, and in five of nine infants who had experienced at least one previous extubation (P < 0.05). PaCO₂ was virtually unchanged from preextubation levels 2 h after extubation, but declined significantly at 32 h from 59.8 (45.0–92.3) mmHg to 50.7 (39.8–74.4) mmHg (P < 0.01). PaCO₂ returned to preextubation levels upon discontinuation of nHFOV.

Conclusion.This small observational study demonstrates that nHFOV can be successfully applied to wean premature infants from ventilator support.

Keywords:

• Extubation failure
• nHFOV
• preterm infants
• reintubation
• ventilator weaning

Acknowledgment

The authors thank Mrs. Jasmin Matzigkeit, Berlin, Germany, and Dr. Scott Butler of English Manager Science Editing, Sydney, Australia, for data editing and linguistic correction, respectively.

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.