Non-invasive high-frequency ventilation versus bi-phasic continuous positive airway pressure (BP-CPAP) following CPAP failure in infants <1250 g: a pilot randomized controlled trial.
Non-invasive high-frequency ventilation (NIHFV), a relatively new modality, is gaining popularity despite limited data. We sought to evaluate the effectiveness of NIHFV versus bi-phasic continuous positive airway pressure (BP-CPAP) in preterm infants failing CPAP.



Infants with BW<1250 g on CPAP were randomly assigned to NIHFV or BP-CPAP if they met pre-determined criteria for CPAP failure. Infants were eligible for randomization after 72 h age and until 2000 g. Guidelines for adjustment of settings and criteria for failure of assigned mode were implemented. The primary aim was to assess feasibility of a larger trial. In addition, failure of assigned non-invasive respiratory support (NRS) mode, invasive mechanical ventilation (MV) 72 h and 7 days post-randomization, and bronchopulmonary dysplasia (BPD) were assessed.



Thirty-nine infants were randomized to NIHFV (N=16) or BP-CPAP (N=23). There were no significant differences in mean (s.d.) postmenstrual age (28.6 (1.5) versus 29.0 (2.3) weeks, P=0.47), mean (s.d.) weight at randomization (965.0 (227.0) versus 958.1 (310.4) g, P=0.94) or other baseline demographics between the groups. Failure of assigned NRS mode was lower with NIHFV (37.5 versus 65.2%, P=0.09), although not statistically significant. There were no differences in rates of invasive MV 72 h and 7 days post-randomization or BPD.



NIHFV was not superior to BP-CPAP in this pilot study. Effectiveness of NIHFV needs to be proven in larger multi-center, appropriately powered trials before widespread implementation.
Department of Paediatrics, McMaster University, Hamilton, ON, Canada.
A
A
Mukerji
Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada.
K
K
Sarmiento
Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada.
B
B
Lee
Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada.
K
K
Hassall
Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
V
V
Shah
D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000517:prevention & control*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods*; D009864:Ontario; D010865:Pilot Projects; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D017211:Treatment Failure
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