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Ventilatory efficiency during high-frequency oscillatory ventilation with volume guarantee in preterm infants
Kamal Ali1,2,3, Mesaed Alsenani1, Saad Alshareedah1
1Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
European Journal of Pediatrics
|June 25, 2026
Summary
Ventilator-derived CO2 clearance poorly reflects arterial CO2 levels in preterm infants on HFOV-VG. Ventilatory efficiency shows moderate ability to predict adverse respiratory outcomes, improving with additional respiratory support data.
Area of Science:
- Neonatal physiology
- Respiratory support
- Mechanical ventilation
Background:
- High-frequency oscillatory ventilation with volume guarantee (HFOV-VG) utilizes ventilator-derived indices for CO2 clearance.
- The correlation between ventilator-derived CO2 transport and actual arterial CO2 elimination during HFOV-VG is not fully understood.
Purpose of the Study:
- To assess the relationship between ventilator-derived CO2 clearance and arterial CO2 elimination in preterm infants on HFOV-VG.
- To investigate the factors influencing ventilatory efficiency and its clinical significance.
Main Methods:
- A cohort study of preterm infants (<30 weeks gestation) receiving HFOV-VG within 72 hours of birth.
- Paired minute-level ventilator data with arterial blood gases were analyzed.
- Ventilatory efficiency (weight-normalized DCO2/arterial PCO2) and its temporal patterns were evaluated.
Main Results:
- Arterial PCO2 remained stable despite significant variations in CO2 clearance.
- Ventilatory efficiency varied among infants and over time, influenced by oscillatory frequency.
- Higher ventilatory efficiency correlated with lower rates of death or moderate-to-severe bronchopulmonary dysplasia (BPD).
Conclusions:
- Ventilator-derived CO2 clearance has limited correlation with arterial PCO2 during HFOV-VG.
- Ventilatory efficiency offers moderate predictive value for adverse respiratory outcomes in this population.
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