Tracheal and bronchial injury in high-frequency oscillatory ventilation compared with conventional positive pressure ventilation

Objective The aim of this article was to evaluate high-frequency positive pressure ventilation (HFPPV) compared with high-frequency oscillatory ventilation (HFOV) as a rescue ventilation strategy for patients with congenital diaphragmatic hernia (CDH). HFPPV is a pressure-controlled conventional ventilation method utilizing high respiratory rate and low positive end-expiratory pressure. Study Design Seventy-seven patients diagnosed with CDH from January 2005 to September 2019 who were treated with stepwise progression from HFPPV to HFOV versus only HFOV were included. Fisher's exact test and the Kruskal–Wallis test were used to compare outcomes. Results Patients treated with HFPPV + HFOV had higher survival to discharge (80 vs. 50%, p = 0.007) and to surgical intervention (95.6 vs. 68.8%, p = 0.003), with average age at repair 2 days earlier (p = 0.004). Need for extracorporeal membrane oxygenation (p = 0.490), inhaled nitric oxide (p = 0.585), supplemental oxygen (p = 0.341), and pulmonary hypertension medications (p = 0.381) were similar. Conclusion In CDH patients who fail respiratory support with conventional ventilation, HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effects. Key Points

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Non-invasive high-frequency oscillatory ventilation in preterm infants after extubation: a randomized, controlled trial

Journal of International Medical Research ◽

10.1177/0300060520984915 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052098491

Author(s):

Yan Li ◽

Qiufen Wei ◽

Dan Zhao ◽

Yan Mo ◽

Liping Yao ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Preterm Infants ◽

High Frequency ◽

Controlled Trial ◽

High Frequency Oscillatory Ventilation ◽

Positive Pressure ◽

Non Invasive ◽

Randomized Controlled ◽

Oscillatory Ventilation ◽

High Frequency Oscillatory

Objective To investigate the effectiveness and safety of non-invasive high-frequency oscillatory ventilation (NHFOV) in post-extubation preterm infants. Methods This was a randomized, controlled trial. A total of 149 preterm infants aged between 25 to 34 weeks’ gestational age with a birth weight of <1500 g who required invasive mechanical ventilation on admission were included. After extubation, they were randomized to the NHFOV group (n = 47), nasal intermittent positive pressure ventilation (NIPPV) group (n = 51), or nasal continuous positive airway pressure (NCPAP) group (n = 51). We compared the effectiveness and safety among these three groups. Results A total of 139 preterm infants finally completed the study. The reintubation rate was significantly lower in the NHFOV group than in the other groups. The duration of non-invasive ventilation and the length of hospital stay in the NHFOV and NIPPV groups were significantly shorter than those in the NCPAP group. The incidence of bronchopulmonary dysplasia in the NHFOV and NIPPV groups was significantly lower than that in the NCPAP group. The NHFOV group had significantly less nasal injury than the NCPAP group. Conclusion As post-extubation respiratory support in preterm infants, NHFOV has a lower reintubation rate compared with NCPAP and NIPPV, without increasing the rate of complications.

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High-frequency oscillatory ventilation increases canine pulmonary epithelial permeability

Journal of Applied Physiology ◽

10.1152/jappl.1987.63.5.1871 ◽

1987 ◽

Vol 63 (5) ◽

pp. 1871-1876 ◽

Cited By ~ 8

Author(s):

G. C. Man ◽

I. H. Ahmed ◽

J. W. Logus ◽

S. F. Man

Keyword(s):

Clearance Rate ◽

High Frequency ◽

Intercellular Junctions ◽

Intermittent Positive Pressure Ventilation ◽

High Frequency Oscillatory Ventilation ◽

Positive Pressure ◽

Epithelial Permeability ◽

Oscillatory Ventilation ◽

Pulmonary Epithelial Permeability ◽

High Frequency Oscillatory

To investigate the effect of high-frequency oscillatory ventilation (HFOV) on the pulmonary epithelial permeability, we measured the clearance rate of nebulized sodium pertechnetate (99mTcO4-) and diethylenetriaminepentaacetate (99mTc-DTPA) before and after a 4-h period of mechanical ventilation in anesthetized mongrel dogs. The animals also underwent experiments with 4 h of spontaneous breathing (SB) and intermittent positive-pressure ventilation (IPPV) with and without addition of positive end-expiratory pressure (PEEP) for comparison. After IPPV and SB there was no change in the clearance rate of either 99mTcO4- or 99mTc-DTPA. After IPPV + PEEP and HPOV (8 and 16 Hz), there was an increase in the clearance rate of 99mTc-DTPA, but an increase in clearance rate of 99mTcO4- was seen after IPPV + PEEP only. In a separate group of dogs an increase in end-tidal lung volume was demonstrated after 4 h of ventilation with IPPV + PEEP (but not after HFOV), and this may account for the measured increase in 99mTcO4- clearance. We conclude that an increase in 99mTc-DTPA clearance rate after HFOV signifies an increase in pulmonary epithelial permeability, possibly through the mechanism of damage to the intercellular junctions during HFOV.

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