Noninvasive High-Frequency Oscillatory Ventilation: A Retrospective Chart Review

Objective This study aimed to review the feasibility of nasal high-frequency oscillatory ventilation (NHFOV) in preventing reintubation in preterm infants Study Design This is a retrospective cohort study of all premature newborn infants placed on NHFOV in a single-center neonatal intensive care unit. Results Twenty-seven patients (birth weight: 765 +/- 186 g, gestational age: 28 +/- 2 weeks) were commenced on NHFOV on 32 occasions. NHFOV was used immediately postextubation as the primary mode of noninvasive ventilation (NIV; prophylaxis) in 10 of 32 occasions and as "rescue" (failure of NCPAP or biphasic CPAP) in 22 of 32 occasions. Treatment with NHFOV was successful in 22 occasions (69%) while on 10 occasions (31%) reintubation was required within 72 hours. In the rescue group, there was significant reduction in the mean (standard deviation [SD]) number of apneas (0.9 +/- 1.07 vs. 0.3 +/- 0.29,p < 0.005), but there were no significant changes in the PCO(2)level (52 [ +/- 9.8] vs. 52 [ +/- 8.6] mm Hg,p = 0.8), or the FiO(2)requirement (0.39 +/- 0.19 vs. 0.33 +/- 0.10,p = 0.055) before and after commencing NHFOV, respectively. Conclusion The use of NHFOV is feasible as a prophylactic or rescue mode of NIV following extubation and was associated with decrease in the number of apneas without significant changes in PCO(2)or oxygen requirements. A well-designed randomized control trial is needed to determine the indications, clinical outcomes, and safety of this treatment modality.