Application of Different Noninvasive Ventilation Modes Combined with Caffeine Citrate in the Treatment of Apnea of Prematurity / 医学研究杂志

Objective To explore the optimal protocol for treating apnea of prematurity by analyzing the effectiveness of different noninvasive assisted ventilation modes combined with caffeine citrate in preterm infants.Methods From October 2019 to August 2022,a total of 90 infants with apnea of prematurity(gestational age≤34 weeks)were chosen as research objects in the Neonatal Intensive Care Unit of the Second Affiliated Hospital of Bengbu Medical College,and the relevant data were retrospectively analyzed.The children were divided into nasal continuous positive airway pressure(NCPAP)combined with caffeine citrate group(44 cases),and noninvasive inter-mittent positive pressure ventilation(NIPPV)sequential NCPAP combined with caffeine citrate group(46 cases)according to the differ-ent treatment protocols adopted in the clinical treatment process.The general clinical data,apnea efficacy,treatment time,and occur-rence of adverse effects between the two groups of prematurity were compared statistically by t-test,x2test,and Mann-Whitney rank sum test.Results The total efficiency of the NIPPV sequential NCPAP combined with caffeine citrate group in treating apnea of prematu-rity was 91.30％,higher than 86.36％in NCPAP combined with caffeine citrate group,and the difference was statistically significant(P＜0.05).Statistically significant differences in failure of non-invasive ventilation and associated treatment time between the two groups(P＜0.05)were observed.The difference between the two groups in the incidence of feeding intolerance and nasal injury was sta-tistically significant(all P＜0.05).Conclusion Early adoption of NIPPV sequential NCPAP ventilation mode can achieve better clinical results,shorten treatment and hospitalization time,and have relatively fewer adverse effects than traditional NCPAP alone in treating apnea of prematurity,which is worthy of clinical promotion.

O modo PSV apresenta piores desfechos em relação ao desmame quando comparado com outros modos ventilatórios de pacientes com exacerbação aguda da doença pulmonar obstrutiva crônica: revisão sistemática / The PSV mode has worse weaning outcomes when compared to other ventilatory modes in patients with an acute exacerbation of chronic obstructive pulmonary disease: systematic review

INTRODUÇÃO: A Doença Pulmonar Obstrutiva Crônica (DPOC) é um distúrbio crônico e progressivo, que evolui com o declínio da função pulmonar. Embora sua cronicidade, são comuns períodos de agudização acompanhados de Insuficiência Respiratória Aguda hipercápnica, requisitando permanência nas Unidades de Terapia Intensiva (UTI) e Ventilação Mecânica Invasiva (VMI) para reversão da falência respiratória. O desmame na DPOC ocupa até 58% da VM, logo, se faz necessário estratégias específicas para otimização desse processo, com a utilização de modos e ajustes ventilatórios que promovam um desmame precoce e efetivo. OBJETIVO: Verificar os efeitos da Ventilação com Pressão de Suporte quando comparado com modos e estratégias distintas no desmame de pacientes com DPOC. MÉTODOS: Revisão sistemática, construída seguindo critérios do PRISMA, registrada na PROSPERO (CRD42022362228). Considerados elegíveis ensaios clínicos controlados randomizados que avaliaram o modo PSV em comparação com modos e estratégias distintas, em pacientes com diagnóstico de DPOC, em VMI, sem delimitação de ano/idioma. Foram excluídos artigos incompletos, duplicados e indisponíveis aos recursos de recuperação. Desfechos de interesse foram: duração do desmame, tempo de permanência na UTI e mortalidade. A estratégia foi aplicada nas bases: PubMed, Cochrane, SciELO, e Biblioteca Virtual em Saúde. As ferramentas Escala PEDro e RevMan Web foram utilizadas para análise da qualidade dos estudos e risco de viés, respectivamente. RESULTADOS: Incluídos 8 artigos. 6 mostraram significância estatística, apresentando menor tempo de desmame no grupo ASV (24 (20­62) h versus 72 (24­144) h PSV) (p=0,041); mais dias na UTI quando comparado com o modo PAV (p<0,001). PSV foi mais eficaz nos mesmos desfechos quando comparado com a estratégia Tubo-T. Houve diferenças quanto a taxa de mortalidade com o modo NAVA. CONCLUSÃO: Fica evidente que o modo PSV quando em relação a modos ventilatórios assistidos, tem potencial de fornecer piores desfechos associados ao processo de desmame da ventilação invasiva de pacientes com DPOC.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a chronic and progressive disorder that evolves with the decline in lung function. Despite its chronicity, periods of exacerbation accompanied by hypercapnic Acute Respiratory Failure are common, requiring a stay in Intensive Care Units (ICU) and Invasive Mechanical Ventilation (IMV) to reverse respiratory failure. Weaning in COPD occupies up to 58% of the MV, therefore, specific strategies are needed to optimize this process, using ventilatory modes and adjustments that promote early and effective weaning. OBJECTIVE: To verify the effects of Pressure Support Ventilation when compared with different modes and strategies in weaning patients with COPD. METHODS: Systematic review, constructed following PRISMA criteria, registered at PROSPERO (CRD42022362228). Randomized controlled clinical trials that evaluated the PSV mode in comparison with different modes and strategies, in patients diagnosed with COPD, on IMV, without delimitation of year/language, were considered eligible. Incomplete, duplicate and unavailable articles were excluded. Outcomes of interest were: duration of weaning, length of stay in the ICU and mortality. The strategy was applied in the bases: PubMed, Cochrane, SciELO, and Biblioteca Virtual em Saúde. The PEDro Scale and RevMan Web tools were used to analyze study quality and risk of bias, respectively. RESULTS: Included 8 articles. 6 showed statistical significance, showing shorter weaning time in the ASV group (24 (20­62) h versus 72 (24­144) h PSV) (p=0.041), and more days in the ICU when compared to the PAV mode (p<0.001). PSV was more effective on the same outcomes when compared with the T-tube strategy. There were differences in the mortality rate with the NAVA mode. CONCLUSION: It is evident that the PSV mode, when compared to assisted ventilation modes, has the potential to provide worse outcomes associated with the process of weaning from invasive ventilation in patients with COPD.

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.

Effect of lung protective ventilation on lung ventilation function, serum serum Clara cell protein 16 level and prognosis in patients undergoing gynecological laparoscopic surgery / 中国医师进修杂志

Objective:To analyze the effect of lung protective ventilation on lung ventilation function and serum Clara cell protein 16 (CC16) level in patients undergoing gynecological laparoscopic surgery.Methods:The clinical data of 80 gynecological patients who underwent laparoscopic surgery in Yancheng City Jianhu County People′s Hospital from October 2018 to December 2020 were randomly divided into group A and group B by random number table, each group with 40 cases. The patients in group A were treated with intermittent positive-pressure ventilation, and the patients in group B were ventilated with whole course ventilation mode. The pulmonary ventilation function, CC16 level and postoperative pulmonary complications were observed before anesthesia, 10 min of pneumoperitoneum, 30 min of pneumoperitoneum, 5 min of pneumoperitoneum stop and 2 h after operation. The patients were divided into groups according to whether with pulmonary complications, and their pulmonary ventilation function and serum CC16 level were compared. The predictive value of the above indexes for pulmonary complications was analyzed by receiver operating characteristic (ROC) curve.Results:Repeated measurement analysis of variance showed that alveolar arterial oxygen differential pressure (PA-aDO 2) were significant differences in time point factors, time point interaction factors and group factors ( P<0.05); CC16 index were significant differences in time point factor and group factor ( P<0.05). According to the observation from postoperative to discharge, 4 patients (10.0%) in group A had pulmonary complications, 15 cases (37.5%) had pulmonary complications in group B, the levels of PA-aDO 2 and CC16 in patients with complications were significantly higher than those in patients without complications: group A:(332.9 ± 2.0) mmHg (1 mmHg = 0.133 kPa) vs. (290.4 ± 13.2) mmHg, (53.5 ± 1.5) μg/L vs. (39.5 ± 6.5) μg/L; group B: (339.1 ± 8.8) mmHg vs. (305.7 ± 17.9) mmHg, (41.5 ± 4.2) μg/L vs. (39.7 ± 5.8) μg/L, there were statistical differences ( P<0.05). ROC curve analysis showed that the area under the curve(AUC) of PA-aDO 2 and CC16 in predicting pulmonary complications in group A were 0.882 and 0.833, in group B was 0.885 and 0.731. Conclusions:Lung protective ventilation has little effect on lung ventilation function and serum CC16 in patients with gynecological laparoscopic surgery, and the probability of pulmonary complications is lower. The pulmonary ventilation function and CC16 have certain value in predicting postoperative pulmonary complications.

Infección respiratoria baja en neonatos asociados a ventilación mecánica

Introducción: la infección respiratoria baja constituye una importante causa de mortalidad y morbilidad en el recién nacido. Objetivo: identificar los factores de riesgo para la infección respiratoria baja asociada a la ventilación mecánica artificial invasiva y no invasiva en los recién nacidos ingresados en la UCIN del servicio de Neonatología del Hospital General Docente Carlos Manuel de Céspedes de enero 2017 hasta diciembre del 2019. Métodos: se realizó un estudio analítico de casos y controles. Los grupos de estudio estuvieron conformados por 25 casos y 50 controles respectivamente. Resultados: las variables edad gestacional antes las 37 semanas de gestación, el bajo peso al nacer poseen dos veces o más riesgos de padecer una infección respiratoria baja asociada a la ventilación mecánica de forma significativa con una p<0,05; la estadía mayor de 3 días en ventilación mostró significancia con una p: 0,031; entre los diagnósticos que llevaron a la ventilación mecánica fue la enfermedad de la membrana hialina con una p: 0,025. Conclusiones: La edad gestacional menor de 37 semanas, el peso al nacer menor de 2 500 gramos, el tiempo ventilatorio de más de 3 días y el diagnóstico de la enfermedad de la membrana hialina fueron las variables significativas.

Introduction: lower respiratory infection is an important cause of mortality and morbidity in the newborn. Objective: to identify the risk factors for lower respiratory infection associated with invasive and non-invasive artificial mechanical ventilation in newborns admitted to the NICU of the Neonatology service of the Carlos Manuel de Céspedes Teaching General Hospital from January 2017 to December 2019. Methods: an analytical case-control study was conducted. The study groups consisted of 25 cases and 50 controls, respectively. Results: the variables gestational age before 37 weeks of gestation, low birth weight have twice or more risks of suffering a lower respiratory infection associated with mechanical ventilation significantly with a p<0.05; The stay longer than 3 days in ventilation showed significance with a p: 0.031; Among the diagnoses that led to mechanical ventilation was hyaline membrane disease with a p: 0.025. Conclusions: Gestational age less than 37 weeks, birth weight less than 2 500 grams, ventilatory time of more than 3 days and diagnosis of hyaline membrane disease were the significant variables.

Introdução: a infecção respiratória inferior é uma importante causa de mortalidade e morbidade no recém-nascido. Objetivo: identificar os fatores de risco para infecção respiratória inferior associados à ventilação mecânica artificial invasiva e não invasiva em recém-nascidos internados na UTIN do serviço de Neonatologia do Hospital Geral Universitário Carlos Manuel de Céspedes no período de janeiro de 2017 a dezembro de 2019. Métodos: foi realizado um estudo analítico caso-controle. Os grupos de estudo foram constituídos por 25 casos e 50 controles, respectivamente. Resultados: as variáveis idade gestacional antes de 37 semanas de gestação, baixo peso ao nascer apresentam duas ou mais vezes ou mais riscos de sofrer uma infecção respiratória inferior associada à ventilação mecânica significativamente com p<0,05; A permanência superior a 3 dias em ventilação mostrou significância com p: 0,031; Entre os diagnósticos que levaram à ventilação mecânica estava a doença da membrana hialina com p: 0,025. Conclusões: Idade gestacional inferior a 37 semanas, peso ao nascer inferior a 2.500 gramas, tempo ventilatório superior a 3 dias e diagnóstico de doença da membrana hialina foram as variáveis significativas.

Efficacy and safety of inhalation of pulmonary surfactant using vibrating mesh nebulizers combined with nasal continuous positive airway pressure in the treatment of neonatal respiratory distress syndrome / 中华危重病急救医学

Objective:To investigate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) combined with inhalation of pulmonary surfactant (PS) using vibrating mesh nebulizers in the treatment of neonatal respiratory distress syndrome (RDS).Methods:A prospective study was performed on premature infants with RDS admitted to the First Affiliated Hospital of Bengbu Medical College between December 2020 and June 2021. They were randomly assigned into vibrating mesh atomization technology group and intubation-surfactant-extubation (INSURE) technology group. The two groups were treated with NCPAP combined with PS. PS in the vibrating mesh atomization technology group was inhaled into the lungs by the new vibrating mesh atomization technology, while PS in the INSURE group was injected into the lungs by endotracheal tube. The pH value, arterial partial pressure of carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2), mechanical ventilation via endotracheal tube (MVET) demand rate, duration of respiratory support, secondary use of PS, complications, and hospital mortality were compared between the two groups. The occurrences of adverse events in the two groups were recorded. Results:A total of 42 preterm infants were finally enrolled, including 20 cases in the vibrating mesh atomization technology group and 22 cases in the INSURE technology group. There were no significant differences in blood gas analysis and PaO 2/FiO 2 before PS administration between the two groups. One hour after PS administration, blood gas analysis and PaO 2/FiO 2 were significantly improved in both groups. Compared with the INSURE technology group, the improvement of PaO 2/FiO 2 was more obvious in the vibrating mesh atomization technology group [mmHg (1 mmHg≈0.133 kPa): 198±34 vs. 173±39, P < 0.05], but no significant difference in pH value or PaCO 2 was found between the two groups. The duration of respiratory support in the vibrating mesh atomization technology group was significantly shorter than that in the INSURE technology group (hours: 96±13 vs. 120±18, P < 0.01), but there was no statistical difference in MVET demand rate [5.0% (1/20) vs. 13.6% (3/22), P > 0.05]. The incidence of periventricular-intraventricular hemorrhage (PVH-IVH) in the vibrating mesh atomization technology group was less than that in the INSURE technology group [0% (0/20) vs. 18.2% (4/22)], but no statistical difference was found ( P > 0.05). No significant differences in the secondary use rate of PS and incidence of bronchopulmonary dysplasia (BPD) or other complications were found between the vibrating mesh atomization technology group and the INSURE technology group [5.0% (1/20) vs. 9.1% (2/22), 5.0% (1/20) vs. 4.5% (1/22), both P > 0.05]. There were no deaths or serious adverse events such as pneumothorax, pulmonary hemorrhage, periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in both groups. Conclusion:Compared with the INSURE technique, NCPAP combined with vibrating mesh atomization technology was also effective and safe in the treatment of RDS, which could significantly improve PaO 2/FiO 2 and shorten the duration of respiratory support. Thus, it was worthy of clinical popularization and application.

Efficacy analysis of nasal intermittent positive pressure ventilation and minimally invasive surfactant therapy in very preterm infants with respiratory distress syndrome / 中国新生儿科杂志

Objective:To study the efficacy of nasal intermittent positive pressure ventilation (NIPPV) and minimally invasive surfactant therapy (MIST) in very preterm infants with respiratory distress syndrome (RDS).Methods:From January to December 2020, very preterm infants (gestation age ≤30 weeks) with RDS born and treated in our hospital were randomly assigned into NIPPV group and nasal continuous positive airway pressure (NCPAP) group. Both groups were treated with MIST technique. The following items were compared between the two groups:adverse reactions during MIST, partial pressure of carbon dioxide (PaCO 2) at 2 h after MIST, the incidences of intubation within 72 h, two or more doses of pulmonary surfactant (PS), frequent apnea, other complications and the parameters of respiratory support treatment. Results:A total of 62 cases were included, with 32 in the NIPPV group and 30 in the NCPAP group. Compared with the NCPAP group, the NIPPV group had lower incidences of bradycardia (6.3% vs. 30.0%), decreased oxygen saturation (12.5% vs. 40.0%) and apnea (6.3% vs. 30.0%) during MIST ( P<0.05). No significant difference existed in the incidence of regurgitation ( P>0.05). PaCO 2 at 2 h after MIST [40.1(38.2,43.8)mmHg vs. 48.3(44.1,50.0)mmHg], the incidences of intubation within 72 h (6.3% vs. 30.0%), two or more doses of PS (6.3% vs. 30.0%)and frequent apnea (6.3% vs. 30.0%) in NIPPV group were lower than NCPAP group ( P<0.05). No significant differences existed between the two groups on the following items: the durations of invasive ventilation, non-invasive ventilation, oxygen therapy, the incidences of bronchopulmonary dysplasia, intraventricular hemorrhage (≥Ⅲ), periventricular leukomalacia, retinopathy of prematurity (≥Ⅱ), necrotizing enterocolitis (≥Ⅱb), nasal injury, air leak and death ( P>0.05). Conclusions:Combining NIPPV and MIST can reduce the incidence of adverse reactions during PS administration without increasing respiratory support duration and common complications in preterm infants. It is recommended for clinical use.

Encuesta sobre el procedimiento de extubación en las unidades de cuidados intensivos de Buenos Aires, Argentina / Survey on the extubation procedure in intensive care units in Buenos Aires, Argentina

RESUMEN Objetivo: Conocer la práctica habitual del manejo de la vía aérea durante el procedimiento de extubación mediante una encuesta online a profesionales de las unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos, Argentina. Métodos: Estudio descriptivo transversal de tipo encuesta online del 11 de febrero al 11 de marzo de 2013. Se envió por correo electrónico una invitación voluntaria y anónima para acceder a la encuesta a 500 participantes a partir de una base de datos confeccionada por los investigadores de este estudio. Resultados: De un total de 500 participantes, 217 (44%) respondieron la encuesta. El 59,4% son kinesiólogos. Ciento noventa y cinco (89,9%) profesionales se desempeñan en atención de adultos. Con respecto al procedimiento de desinflado del balón y extubación, 203 (93,5%) realizan aspiración endotraqueal y 27 (12,5%) emplean presión positiva. El 53,5% de los participantes informó haber tenido en los últimos 3 meses complicaciones inmediatas a este procedimiento. Se informaron un total de 163 complicaciones, siendo el estridor el más prevalente (52,7%). Conclusión: La mayoría de los profesionales de unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires, Argentina, emplea aspiración endotraqueal sin aplicar presión positiva durante el procedimiento de extubación.

ABSTRACT Objective: To examine the usual practice of airway management during the extubation procedure through an online survey to professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina. Methods: A cross-sectional descriptive study online survey was conducted from February 11 to March 11, 2013. A database was generated, and a voluntary and anonymous invitation to access the survey was sent by email to 500 participants. Results: Out of a total of 500 participants, 217 (44%) responded to the survey, of whom 59.4% were physical therapists. One hundred ninety-five (89.9%) professionals were working in adult care. Regarding the cuff deflation procedure and extubation, 203 (93.5%) performe endotracheal suctioning, and 27 (12.5%) use positive pressure. Approximately 53.5% of participants reported having experienced immediate complications with this procedure in the last three months. In all, 163 complications were reported, and stridor was the most prevalent (52.7%). Conclusion: Most professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina, use endotracheal suctioning without applying positive pressure during extubation.

Clinical observation on Quyu-Huatan decoction combined with noninvasive positive pressure ventilation in treatment with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type / 国际中医中药杂志

Objective@#To observe the clinical effect of Quyu-Huatan decoction combined with noninvasive positive pressure ventilation in treatment with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type.@*Methods@#A total of 64 patients with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type were divided into observation group and control group according to the random number table method, with 32 cases in each group. The control group received routine clinical treatment combined with noninvasive positive pressure ventilation, while the observation group was treated with Quyu-Huatan decoction on the basis of the control group. After 4 weeks of treatment, the polysomnography (PSG) index (the apnea hypopnea index, AHI, the Oxygen saturation, SaO2, the pulse pressure, PP, the longest apnea time), the degree of lethargy (Epworth sleepiness scale, ESS), the quality of sleep (Pittsburgh sleep quality index, PSQI) and the quality of life (Calgary mass index of life quality index, SAQLI) before and after the treatment of two groups were observed, and the clinical effect was compared.@*Results@#The total effective rate of the observation group was 87.5% (28/32), which was significantly higher than that 68.8% (22/32) of the control group (Z=-3.187, P=0.000). After treatment, the AHI (8.59 ± 0.93 times/h vs. 18.62 ± 2.44 times/h, t=5.735), the PP (35.96 ± 4.02 mmHg vs. 43.33 ± 4.70 mmHg, t=5.083) and the longest apnea time (11.93 ± 1.86 s vs. 17.94 ± 2.43 s, t=4.863) of the observation group were significant lower than those of the control group (P<0.05), while the SaO2 content (93.07% ± 10.03% vs. 82.36% ± 9.37%, t=5.812) of the observation group were significant higher than those of the control group (P<0.05). After treatment, the ESS (5.33 ± 0.33 vs. 8.73 ± 0.96, t=4.682) and the PSQI (2.25 ± 0.31 vs. 5.68 ± 0.77, t=4.872) of the observation group were significant lower than those of the control group (P<0.05), and the SAQLI (6.12 ± 0.59 vs. 4.36 ± 0.53, t=4.631) of the observation group were significant higher than those of the control group (P<0.05).@*Conclusions@#The application of Quyu-Huatan decoction combined with noninvasive positive pressure ventilation in treatment with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type can improve sleep disordered breathing, relieve drowsiness, and improve sleep quality and quality of life.

Efficacy of sequential heated humidified high flow nasal cannula after extubation in premature infants with pulmonary hemorrhage / 中华实用儿科临床杂志

Objective@#To investigate the clinical efficacy of sequential heated humidified high flow nasal ca-nnula(HHHFNC)after extubation in premature infants with pulmonary hemorrhage.@*Methods@#A total of 52 premature infants with pulmonary hemorrhage were selected, who were randomly (by means of random number table) given nasal intermittent positive pressure ventilation(NIPPV)(27 cases) and HHHFNC (25 cases) as a sequential respiratory su-pport from January 2017 to January 2018 at Suzhou Hospital of Nanjing Medical University were selected.The incidence of the basic conditions of the 2 groups of premature infants [gestational age, birth weight, mechanical ventilation days after pulmonary hemorrhage, high-frequency ventilation, usage of nitric oxide(NO)], blood gas analysis indicators at 1 h before extubation and ventilator parameters including the arterial oxygen partial pressure [pa(O2)], arterial partial pressure of carbon dioxide [pa(CO2)], pH value, positive end-expiratory pressure(PEEP), respiratory rates (RR), peak inspiratory pressure (PIP), fraction of inspiration oxygen (FiO2) were compared.The blood gas analysis after extubation [pa(O2), pa(CO2), pH value] at 1 h, outcome events/complications at the end of treatment (reintubation, uration of oxygen therapy after pulmonary hemorrhage, hospitalization days, bronchial pulmonary hypoplasia, ventilator associated pneumonia, feeding intolerance, neonatal necrotizing enterocolitis, pneumothorax) were also compared.@*Results@#There were no significant differences between the NIPPV group and the HHHFNC group in the following items: gestational age, birth weight, mechanical ventilation days after pulmonary hemorrhage, high-frequency ventilation, usage of NO[(30.5±2.9) weeks vs.(31.6±2.7) weeks, 1 325(818) g vs.1 400(800) g, 5 days vs.4 days, 25.9%(7/27 cases) vs.24.0%(6/25 cases), 7.4%(2/27 cases)vs.0(0/25 cases), all P>0.05]. There were no significant differences between the two groups in blood gas analysis indicators before extubation at 1 h and ventilator parameters [pa(O2), pa(CO2), pH value, PEEP, RR, PIP, FiO2], blood gas analysis [pa(O2), pa(CO2), pH value] after extubation at 1 h (all P>0.05); There were no significant differences between the two groups in reintubation, hospitalization days, bronchial pulmonary hypoplasia, ventilator associated pneumonia, feeding intolerance, neonatal necrotizing enterocolitis, pneumothorax [7.4%(2/27 cases) vs.4.0%(1/25 cases), 43(29) days vs.41(22) days, 40.7%(11/27 cases ) vs.16.0%(4/25 cases), 11.1%(3/27 cases) vs.12.0%(3/25 cases), 37.0%(10/27 cases) vs.32.0%(8/25 cases), 7.4%(2/27 cases ) vs.12.0%(3/25 cases), 7.4%(2/27 cases) vs.12.0%(3/25 cases)] (all P>0.05). The duration of oxygen therapy after pulmonary hemorrhage in the HHHFNC group was shorter than that in the NIPPV group [25(30) days vs.9(22) days, P<0.05].@*Conclusions@#As a sequential respiratory support for preterm infants with pulmonary hemorrhage, HHHFNC has shorter duration of oxygen therapy after pulmonary hemorrhage than that of NIPPV, suggesting that HHHFNC is an ideal non-invasive ventilation treatment.