Nasal high frequency oscillatory highflow therapy in preterm infants: A randomized crossover trial

Area of Science:

• Neonatal respiratory support
• Pediatric critical care
• Respiratory physiology

Background:

• Highflow nasal cannula (HFNC) therapy is widely used for respiratory support in preterm infants.
• Oscillatory ventilation techniques aim to improve gas exchange and lung mechanics.
• Osciflow combines HFNC with superimposed high-frequency oscillations.

Purpose of the Study:

• To evaluate the clinical effectiveness and safety of osciflow compared to standard HFNC in preterm infants.
• To investigate the physiological mechanisms of osciflow using electrical impedance tomography (EIT).

Main Methods:

• A prospective, randomized, single-center crossover trial involving 30 preterm infants.
• Infants received either osciflow or HFNC for 180 minutes each.
• Primary outcome: difference in combined desaturations (SpO2 < 80%) and bradycardia (HR < 80 bpm). EIT monitored lung volumes.

Main Results:

• No significant difference in the combined number of desaturations and bradycardia between osciflow and HFNC (median difference -2; p=0.37).
• Safety outcomes (nasal trauma, pneumothorax, treatment failure) and pain scores were similar between groups.
• EIT confirmed transmission of 6 Hz oscillations during osciflow, with a mean oscillatory to tidal volume ratio of 9%.

Conclusions:

• Osciflow did not demonstrate superior efficacy in reducing desaturations and bradycardia compared to standard HFNC in preterm infants.
• While osciflow transmitted small oscillatory volumes to the lungs, it was found to be safe and well-tolerated.
• Further research may be needed to optimize osciflow parameters for potential clinical benefits.