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Transition from high-frequency oscillation ventilation to neurally adjusted ventilatory assist in extremely preterm
Yusuke Ikushima1, Katsuya Hirata1, Takayuki Iwaibara1
1Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
Background:
Bronchopulmonary dysplasia (BPD) affects long-term respiratory function. Since oxygen toxicity and ventilator-induced lung injury harm immature lungs and contribute to BPD development, careful ventilator management is essential. Reports comparing neurally adjusted ventilation assist (NAVA) with high-frequency oscillation ventilation (HFOV) in extremely preterm infants are limited. This study aimed to evaluate the impact of transitioning from HFOV to NAVA on oxygenation in extremely preterm infants.
Methods:
A retrospective cohort study was conducted on infants born at <27 weeks' of gestation at Osaka Women's and Children's Hospital, Japan between January 2021 and May 2023. Minute-by-minute data were collected for 72 h before and after transitioning from HFOV to NAVA. The Wilcoxon signed-rank test compared the baseline characteristics and outcomes of infants for each period.
Results:
Twenty-three infants (27 transition attempts) were included in this study. The median gestational age was 24.7 (24.4-25.2) weeks, the median birth weight was 656 (609-721) g, and the median postmenstrual age during the study period was 28.3 (27.9-29.6) weeks. NAVA significantly improved the fractional inspiratory oxygen (FIO2) (0.27 [0.25-0.30] vs. 0.30 [0.28-0.34], p < 0.01), oxygen saturation index (OSI) (2.74 [2.51-3.29] vs. 3.67 [3.28-4.54], p < 0.01), and mean airway pressure (MAP) (9.8 [9.5-10.1] vs. 12.0 [10.2-12.5], p < 0.01) compared with the values of these parameters during HFOV. The fluctuations in oxygen saturation tended to be higher with NAVA (3.2 [2.6-3.7] vs. 2.4 [1.8-3.0], p < 0.01) compared with HFOV.
Conclusions:
In extremely preterm infants, transitioning from HFOV to NAVA showed significant improvements in the OSI, FIO2, and MAP.
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