Efficacy and safety of noninvasive high-frequency oscillatory ventilation in the treatment of respiratory distress syndrome in premature infants : a Meta-analysis / 中国新生儿科杂志

Objective:To evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (nHFOV) as the initial ventilation mode for respiratory distress syndrome (RDS) in premature infants.Methods:From the establishment of the databases [(PubMed, Embase, Cochrane Library, CNKI, Wanfang database, CQVIP and CBM (SinoMed)] to March 1, 2022, literature on randomized controlled trials (RCTs) using nHFOV and nasal continuous positive airway pressure(NCPAP) as the initial ventilation modes for RDS in premature infants were searched. The qualities of the included literature were evaluated according to Cochrane Evaluation Manual. RevMan 5.4 software was used for Meta-analysis.Results:Seven RCTs involving 786 children were included for the final Meta-analysis, with 395 cases in the nHFOV group and 391 cases in the NCPAP group. The results showed that the nHFOV group had lower intubation rates than the NCPAP group ( OR=0.34, 95% CI 0.22~0.51, P<0.001). No significant differences existed in mortality rates and complication rates between the two groups ( P>0.05). Conclusions:nHFOV as the initial treatment for RDS in premature infants may reduce the incidence of early treatment failure without increasing complications.

Efficacy of noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation as post-extubation respiratory support in preterm infants: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (NHFOV) versus nasal intermittent positive pressure ventilation (NIPPV) as post-extubation respiratory support in preterm infants.@*METHODS@#China National Knowledge Infrastructure, Wanfang Data, Chinese Journal Full-text Database, China Biology Medicine disc, PubMed, Web of Science, and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31, 2022. RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups, including reintubation rate within 72 hours after extubation, partial pressure of carbon dioxide (PCO2) at 6-24 hours after switch to noninvasive assisted ventilation, and the incidence rates of bronchopulmonary dysplasia (BPD), air leak, nasal damage, periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP).@*RESULTS@#A total of 9 randomized controlled trials were included. The Meta analysis showed that compared with the NIPPV group, the NHFOV group had significantly lower reintubation rate within 72 hours after extubation (RR=0.67, 95%CI: 0.52-0.88, P=0.003) and PCO2 at 6-24 hours after switch to noninvasive assisted ventilation (MD=-4.12, 95%CI: -6.12 to -2.13, P<0.001). There was no significant difference between the two groups in the incidence rates of complications such as BPD, air leak, nasal damage, PVL, IVH, and ROP (P>0.05).@*CONCLUSIONS@#Compared with NIPPV, NHFOV can effectively remove CO2 and reduce the risk of reintubation, without increasing the incidence of complications such as BPD, air leak, nasal damage, PVL, and IVH, and therefore, it can be used as a sequential respiratory support mode for preterm infants after extubation.

Application of noninvasive high frequency oscillatory ventilation in neonates with meconium aspiration syn-drome with pulmonary hypertension after extubation / 实用医学杂志

Objective To investigate the clinical value of nasal noninvasive high frequency oscillatory ven-tilation(NHFOV)as a respiratory support after exbutation by comparing it with nasal continuous positive airway pressure(NCPAP)in neonates with meconium aspiration syndrome(MAS)and persistent pulmonary hypertension (PPHN).Methods Infants of MAS with PPHN after exbutation from intensive care unit were randomly divided in-to NHFOV and NCPAP groups. The value of blood oxygen Pressure(PaO2),carbon dioxide partial pressure(Pa-CO2)and PaO2/FiO2at 1 h,12 h,24 h after exbutation were monitored.Results The NHFOV group showed low-er PaCO2than the NCPAP group at 1 h,12 h and 24 h after noninvasive respiratory support[1 h:(41.1 ± 7.2)vs. (45.4 ± 6.7),P=0.000;12 h:(38.9 ± 3.1)vs.(44.6 ± 5.2),P=0.000;24 h:(35.1 ± 8.2)vs.(43.2 ± 7.1),P=0.000].There were no statistically significant difference of both PaO2and PaO2/FiO2at 1 h,12 h,24 h between the two groups(P>0.05).11.43% infants were failed to be extubated in NHFOV group,but 35.29% in NCPAP group, and there was significant difference between the two groups(P=0.021). Conclusion Compared with NCPAP, NHFOV can better reduce carbon dioxide retention in the sequential therapy for neonates after extubation,and it can also decrease the rate of extubation failure.