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
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Manapat Phatigomet
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Supaporn Dissaneevate
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Waricha Janjindamai
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
› Author Affiliations
Funding The study was supported by the Faculty of Medicine, Prince of Songkla University.
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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.

Clinical Trial Registration

This trial has been registered in the ClinicalTrials.gov database ( https://clinicaltrials.gov/ct2/show/NCT04323397 ). First posted registration: March 26, 2020.


Note

This study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving research study participants were approved by the institutional ethics committee. Written informed consent was obtained from all participants.


Authors' Contributions

K.B., M.P., and A.T. designed the data collection instruments, collected data, performed the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. A.T., G.M., S.D., and W.J. conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Supplementary Material



Publication History

Received: 07 April 2023

Accepted: 16 June 2023

Accepted Manuscript online:
20 June 2023

Article published online:
29 July 2023

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