Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial

Kulthida Baingam; Manapat Phatigomet; Anucha Thatrimontrichai; Gunlawadee Maneenil; Supaporn Dissaneevate; Waricha Janjindamai

doi:10.1055/a-2113-3284

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(11): 1495-1503
DOI: 10.1055/a-2113-3284

Original Article

Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial

Kulthida Baingam

¹Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

,

Manapat Phatigomet

¹Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

,

Anucha Thatrimontrichai

¹Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

,

Gunlawadee Maneenil

¹Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

,

Supaporn Dissaneevate

¹Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

,

Waricha Janjindamai

¹Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

› Author Affiliations

Abstract

Objective Nasal high-frequency oscillatory ventilation (nHFOV) and synchronized nasal intermittent positive pressure ventilation (sNIPPV) yield a lower partial pressure of carbon dioxide (pCO₂) after extubation than nasal continuous positive airway pressure. Our aim was to clarify which of the two was superior.

Study Design We performed a crossover randomized study to evaluate pCO₂ level among 102 participants from July 2020 to June 2022. Intubated preterm and term neonates with arterial lines were randomly allocated to nHFOV–sNIPPV or sNIPPV–nHFOV sequences; their pCO₂ levels were measured after 2 hours in each mode. Subgroup analyses were performed for preterm (gestational age <37 weeks) and very preterm (gestational age <32 weeks) neonates.

Results The mean gestational age (nHFOV–sNIPPV, 32.8 vs. sNIPPV–nHFOV, 33.5 weeks) and median birth weight (1,850 vs. 1,930 g) did not differ between the sequences. The mean ± standard deviation pCO₂ level after nHFOV (38.7 ± 8.8 mm Hg) was significantly higher than that after sNIPPV (36.8 ± 10.2 mm Hg; mean difference: 1.9 mm Hg; 95% confidence interval: 0.3–3.4 mm Hg; treatment effect [p = 0.007] but no sequence [p = 0.92], period [p = 0.53], or carryover [p = 0.94] effects). However, the difference in pCO₂ level between the sequences was not statistically significant in the subgroup analyses of preterm and very preterm neonates.

Conclusion After neonatal extubation, the sNIPPV mode was associated with a lower pCO₂ level than the nHFOV mode with no significant difference in preterm and very preterm neonates.

Key Points

Full noninvasive ventilation support is suggested in neonatal ventilation.
pCO₂ level in sNIPPV was lower than in nHFOV.
No differences in pCO₂ levels were observed in either preterm or very preterm neonates.

Keywords

airway extubation - carbon dioxide - high-frequency ventilation - intermittent positive pressure ventilation - newborn - noninvasive ventilation

Full Text

References

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Supplementary Material

Supplementary Material