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Pediatr Res. 2014 Apr;75(4):507-16. doi: 10.1038/pr.2013.254. Epub 2013 Dec 30.

High-frequency nasal ventilation for 21 d maintains gas exchange with lower respiratory pressures and promotes alveolarization in preterm lambs.

Author information

1
Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
2
Division of Epidemiology, University of Utah, Salt Lake City, Utah.
3
1] Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah [2] Department of Internal Medicine, University of Utah, Salt Lake City, Utah; [3] Department of Neurobiology and Anatomy, University of Utah, Salt Lake City, Utah.

Abstract

BACKGROUND:

Short-term high-frequency nasal ventilation (HFNV) of preterm neonates provides acceptable gas exchange compared to endotracheal intubation and intermittent mandatory ventilation (IMV). Whether long-term HFNV will provide acceptable gas exchange is unknown. We hypothesized that HFNV for up to 21 d would lead to acceptable gas exchange at lower inspired oxygen (O2) levels and airway pressures compared to intubation and IMV.

METHODS:

Preterm lambs were exposed to antenatal steroids and treated with perinatal surfactant and postnatal caffeine. Lambs were intubated and resuscitated by IMV. At ~3 h of age, half of the lambs were switched to noninvasive HFNV. Support was for 3 or 21 d. By design, Pao2 and Paco2 were not different between groups.

RESULTS:

At 3 d (n = 5) and 21 d (n = 4) of HFNV, fractional inspired O2 (FiO2), peak inspiratory pressure (PIP), mean airway, intratracheal, and positive end-expiratory pressures, oxygenation index, and alveolar-arterial gradient were significantly lower than matched periods of intubation and IMV. Pao2/FiO2 ratio was significantly higher at 3 and 21 d of HFNV compared to matched intubation and IMV. HFNV led to better alveolarization at 3 and 21 d.

CONCLUSION:

Long-term HFNV provides acceptable gas exchange at lower inspired O2 levels and respiratory pressures compared to intubation and IMV.

PMID:
24378898
PMCID:
PMC3961520
DOI:
10.1038/pr.2013.254
[Indexed for MEDLINE]
Free PMC Article
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