Clinical Study Of Noninvasive High-frequency Oscillatory Ventilation After Extubation In Bronchopulmonary Dysplasia

Objective:To investigate the clinical effect of noninvasive high-frequency oscillatory ventilation（NHFOV）after extubation in preterm infants with bronchopulmonary dysplasia.Methods:The retrospective cohort study of 109 preterm infants with bronchopulmonary dysplasia who received noninvasive respiratory support after extubation in NICU of Jiangxi Maternal and Child Health Hospital from January2017 to December 2022.A total of 109 preterm infants divided into 40 cases in NHFOV group and 69 case with NIPPV.Recording the general clinical data and comparing the treatment efficacy and complications of the two groups.The treatment efficacy was compared between the two groups,including 72-hour reintubation rate,blood gas analysis within 24-hour after NHFOV/NIPPV application,incidence of apnea,time of total invasive ventilation,time of total noninvasive ventilation,oxygen duration,length of hospital stay,degree of BPD,hormone using,and time to total enteral nutrition.Outcomes of complications:retinopathy of prematurity,pulmonary hemorrhage,necrotizing enterocolitis,abdominal distension requiring fasting,intracranial hemorrhage,patent ductus arteriosus,and sepsis.Results:1.A total of 109 peterm infants with BPD were included in this study,including40 in the NHFOV group and 69 in the NIPPV group.There were no significant differences between the two groups in gender,gestational age,birth weight,delivery mode,5-minute Apgar score,pulmonary surfactant using,prenatal maternal use of dexamethasone,premature rupture of membranes,p H,Pa CO₂and Pa O₂of blood gas analysis before extubation,corrected gestational age before extubation and time of first invasive mechanical ventilation.（P>0.05）.2.Clinical outcomes:The 72-hour reintubation rate,the total invasive mechanical ventilation time,and the Pa CO₂level within 24 hours after receiving noninvasive ventilation in NHFOV group were lower than those in NIPPV group（P<0.05）.There were no significant differences in p H and Pa O₂within 24 hours of noninvasive ventilation,incidence of apnea,total noninvasive time,total oxygen days,total hospital stay,BPD classification,total enteral nutrition time and glucocorticoid application between the two groups（P>0.05）.3.Outcomes of complications:There was no significant differences between NHFOV group and NIPPV group in retinopathy of prematurity,abdominal distension requiring fasting,intracranial hemorrhage,necrotizing enterocolitis,patent ductus arteriosus,pulmonary hemorrhage and sepsis（P>0.05）.Conclusion:The application of NHFOV in preterm infants of BPD after extubation can reduce the rate of reintubation within 72 hours and the time of invasive mechanical ventilation,It can effectively remove CO₂and reduce hypercapnia,without increasing the incidence of complications,NHFOV is a safe and effective mode of noninvasive ventilation.