Weaning of neonates from mechanical ventilation by use of nasopharyngeal high-frequency oscillatory ventilation: a preliminary study

Abstract

Objective.?To investigate the feasibility of nasopharyngeal high-frequency oscillatory ventilation (nHFOV) immediately after extubation in difficult-to-wean preterm infants.

Study design.?This was an observational study of 20 mechanically ventilated neonates [median (range) birth weight 635 (382–1020)g, median gestational age 25.3 (23.7–27.6) weeks] at high risk for extubation failure. Nine infants had failed at least one previous extubation. Fourteen infants were given hydrocortisone. All 20 infants were extubated into nHFOV, with a mean airway pressure of 8 cmH₂O, an amplitude of 20 cmH₂O, and a frequency of 10 Hz.

Results.?Infants remained on nHFOV for a median duration of 136.5 (7.0–456.0) h until further weaning to continuous positive airway pressure (n?=14) or reintubation (n?=?6). Reintubation was performed in 1 of 11 infants who had not experienced any previous extubation, and in five of nine infants who had experienced at least one previous extubation (P < 0.05). PaCO₂ was virtually unchanged from preextubation levels 2 h after extubation, but declined significantly at 32 h from 59.8 (45.0–92.3) mmHg to 50.7 (39.8–74.4) mmHg (P < 0.01). PaCO₂ returned to preextubation levels upon discontinuation of nHFOV.

Conclusion.This small observational study demonstrates that nHFOV can be successfully applied to wean premature infants from ventilator support.