In:
Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ, Vol. 107, No. 5 ( 2022-09), p. 551-557
Kurzfassung:
Non-invasive high-frequency oscillatory ventilation (nHFOV) is an extension of nasal continuous positive airway pressure (nCPAP) support in neonates. We aimed to compare global and regional distribution of lung volumes during nHFOV versus nCPAP. Methods In 30 preterm infants enrolled in a randomised crossover trial comparing nHFOV with nCPAP, electrical impedance tomography data were recorded in prone position. For each mode of respiratory support, four episodes of artefact-free tidal ventilation, each comprising 30 consecutive breaths, were extracted. Tidal volumes (V T ) in 36 horizontal slices, indicators of ventilation homogeneity and end-expiratory lung impedance (EELI) for the whole lung and for four horizontal regions of interest (non-gravity-dependent to gravity-dependent; EELI NGD , EELI midNGD , EELI midGD , EELI GD ) were compared between nHFOV and nCPAP. Aeration homogeneity ratio (AHR) was determined by dividing aeration in non-gravity-dependent parts of the lung through gravity-dependent regions. Main results Overall, 228 recordings were analysed. Relative V T was greater in all but the six most gravity-dependent lung slices during nCPAP (all p 〈 0.05). Indicators of ventilation homogeneity were similar between nHFOV and nCPAP (all p 〉 0.05). Aeration was increased during nHFOV (mean difference (95% CI)=0.4 (0.2 to 0.6) arbitrary units per kilogram (AU/kg), p=0.013), mainly due to an increase in non-gravity-dependent regions of the lung (∆EELI NGD =6.9 (0.0 to 13.8) AU/kg, p=0.028; ∆EELI midNGD =6.8 (1.2 to 12.4) AU/kg, p=0.009). Aeration was more homogeneous during nHFOV compared with nCPAP (mean difference (95% CI) in AHR=0.01 (0.00 to 0.02), p=0.0014). Conclusion Although regional ventilation was similar between nHFOV and nCPAP, end-expiratory lung volume was higher and aeration homogeneity was slightly improved during nHFOV. The aeration difference was greatest in non-gravity dependent regions, possibly due to the oscillatory pressure waveform. The clinical importance of these findings is still unclear.
Materialart:
Online-Ressource
ISSN:
1359-2998
,
1468-2052
DOI:
10.1136/archdischild-2021-322990
Sprache:
Englisch
Verlag:
BMJ
Publikationsdatum:
2022
ZDB Id:
2188490-0
