Clinical Study On Nasal High-frequency Oscillation Ventilation Versus Nasal Intermittent Positive Pressure For The Treatment Of Neonatal Respiratory Failure

BackgroundRespiratory failure is one of the most common and critically ill conditions in perinatal neonates,especialy premature infants.Non-invasive ventilation in neonatal respiratory failure gradually increased,the effect is good.At present,including nasal high-frequency oscillation ventilation,nasal intermittent positive pressure ventilation,humidified heated high flow nasal cannula,nasal continuous positive airway pressure and bi-level positive airway pressure.nHFOV creates a continuous positive pressure in the air flow delivered through the nasal or nasal cannula,superimposed above this pressure with high-frequncy oscillations that exceed physiological ventilation,and in turn achieve effective gas exchange.In theory,the nHFOV combines the advantages of HFOV(no need for synchronization;high C02 emissions,less volume/barotrauma)and nCPAP(non-invasive interface to increase functional residual capacity to increase oxygenation)with non-invasive advantages.In order to maintain continuous lung expansion and small tidal volume,it can rapidly improve oxygenation an carbon dioxide removal[1]and reduce the risk of weaning failure.It is considered to be a new and effecive noninvasive ventilation model.NIPPV is given a set number of high-pressure ventilations per minute on the basis of continuous low-level positive pressure ventilation.Compared with nCPAP,NIPPV can increase tidal volume and minute ventilation,restore collapsed alveoli,increase functional residual capacity,reduce respiratory muscle work done in children,and prevent respiratory muscle fatigue[2].Compared with other non-invasive ventilations such as nCPAP and NIPPY,HHHFNC has the same intubation rate and effectiveness after extubation in the treatment of respiratory failure in preterm infants,but the incidence of related complications such as nasal injury is much less[3].HHHFNC and NIPPV had the same effect in prevention of intubation,and there was no significnt difference in the incidence of comlications such as air leakage,nasal injury,BPD,IVH,PDA,NEC,and sepsis[4].nCPAP is a classic non-invasive ventilation support modle for the treatment of neonatal respiratory failure,mainly to reduce airway resistance,increase functional residual capacity,reduce obstructive apnea,increase lung volume and oxygenation.However,nCPAP has the disadvantages of nasal damage,frequent nasal obstruction shift leading to air leakage and increased nursing time[5].BiPAP is a pressure-based air flow generation device that provides pressure support by changing the inspiratory and expiratory airway poaitive pressures(IPAP and EPAP)according to a preset time(T(high),T(low)),the corresponding pressure level(P(high),P(low))adjustment are made.So that the children can breathe spontaneously at two stress levels,but BiPAP in neonatal use is less,mainly for the treatment of adult chronic lung disease.In recent years,non-invasive mechanical ventilation in the treatment of neonatal respiratory failure has received widespread attention,this experiment in patients with neonatal respiratory failure in the early treatment of non-invasive high-frequency oscillatory ventilation or nasal intermittent positive pressure ventilation were compared to verify whether it is more effective.ObjectiveThe purpose of this study was to explore the effect of nHFOV or NIPPV on the treatment of respiratory failure in newborns.MethodsNeonatal infants were divided into nHFOV group and NIPPV group from January 2015 to December 2016 in a neonatal intensive care unit(NICU)of the Second Hospital of Shandong University with respiratory failure.Selection Criteria reference "Practice of neonatology".A total of 67 infants divided into nHFOV group and NIPPV group,in nHFOV group,there were 31 cases,including 17 males and 14 females.The gestational age was(32.2 ± 1.6)weeks and the body weight was(2069.9±332.8)g.In the NIPPV group,there were 36 patients,including 20 males and 16 females.The gestational age was(32.1 ± 1.9)weeks and the weight was(2014.7 ±415.2)g.Primary outcome is the blood gas analysis,efficacy and the prognosis were investigated.The primary outcome was the arterial blood gas such as PH,PaCO2,PaO2 and oxygenate Index(OI)were compared between the two groups in Oh,0.5h,lh,3h,12h.The second outcomes included the incidences of bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),pneumothorax,necrotizing enterocolitis,intraventricular hemorrhage(IVH),the positive rate of sputum culture,total bowel feeding time and total length of hospital stay.Results1.No significant differences were observed in gestational age,sex ratio,birth weight,age,Apgar score,and the blood gas analysis before treatment(P>0.05).2.The blood gas analysis of nHFOV group was no significant differences in 0.5h compard with NIPPV group.The blood gas analysis also showed that PaCO2 in nHFOV group were better than those in NIPPV group 1 hour and 3 hour after non-respiratory support(P<0.05).3.The time of whole bowel feeding and the time of hospitalization were significantly lower in nHFOV group than that in NIPPV group(P<0.05).4.There was no significant difference in the incidence of pneumothorax,BPD,IVH,NEC,ROP and so on.Conclusions1.nHFOV and NIPPV can significantly improve lung oxygenation in children with neonatal respiratory failure.2.nHFOV is more conducive to improvement of ventilation function than NIPPV,more effective removal of carbon dioxide,and correction of acidosis.