Clinical Study On The Efficacy And Safety Of Non-invasive High Frequency Ventilation In The Treatment Of Premature Infant Acute Respiratory Failure

Background and ObjectiveNeonatal respiratory failure（NRF）is a syndrome that causes circulatory hypoxia and/or carbon dioxide retention due to various respiratory and/or ventilation dysfunction.At present,the main treatment methods are:invasive and non-invasive ventilator application,the use of pulmonary surfactant,nitric oxide inhalation and extracorporeal membrane lung technology.Among them,the most widely used is still the use of various invasive and non-invasive auxiliary ventilation and pulmonary surfactant.Invasive mechanical ventilation can often save the lives of children with respiratory failure,but it also has a high incidence of complications,including bronchopulmonary dysplasia,pulmonary leakage,nosocomial infectious pneumonia and subsonic stenosis,etc.,which affect the long-term quality of life of children to some extent.At present,according to a study by noninvasive assisted ventilation has not influence of bronchial pulmonary dysplasia（bronchopulmonary dysplasia,BPD）and the incidence of a huge advantage,it got more and more attention,in the treatment of neonatal respiratory failure occupies a pivotal position.Noninvasive high-frequency ventilation（nasal high-frequency oscillation ventilation,nHFOV）is a new kind of respiratory support pattern,this pattern through nasal ventilation pipe,mask or nasal pharynx will oscillation wave pressures in the lungs and play a role of respiratory support.In recent years,there have also been domestic studies on nHFOV in the treatment of neonatal respiratory distress syndrome,wet lung,and post-withdrawal support,but there have been few reports on the application of nHFOV as the initial assisted breathing mode to treat neonatal respiratory failure,especially for premature infants.This paper use nHFOV children with respiratory failure with nasal continuous positive airway pressure（cpap）(nasalContinuous positive airway pressure（nCPAP）initial treatment was compared to evaluate the efficacy and safety of nHFOV objectively.Methods1.Subjects:premature infants hospitalized in the neonatal intensive care unit（NICU）of anhui children’s hospital from June 2016 to June 2017,who were diagnosed with respiratory failure and required non-invasive ventilation,were selected as subjects.The diagnostic criteria of neonatal respiratory failure refer to the diagnostic criteria of respiratory failure in practical neonatology.Inclusion criteria:（1）the gestational age was less than 34 weeks,and the clinical diagnosis was consistent with neonatal respiratory failure;（2）need non-invasive auxiliary ventilation.Exclusion criteria:severe congenital heart disease,diaphragmatic hernia,cleft palate,severe asphyxia,tracheal intubation,mechanical ventilation,and death within 24 hours of admission.2.General information of the two groups of children:a total of 42 children were enrolled.The subjects were divided into nHFOV group and nCPAP group by random number method.Among them,nHFOV group included 15 males and 7 females,gestational age（30.3 2.1）（28-32 weeks）,body mass（1.62 0.34）（1.28-1.96）kg,16 cases of neonatal respiratory distress syndrome,4 cases of apnea,and 2 cases of neonatal aspiration pneumonia.NCPAP group:14 males and 6 females,gestational age（31.2 2.4）（28-34）weeks,body mass（1.84 0.41）（1.43-2.25）kg,12 cases of neonatal respiratory distress syndrome,5 cases of apnea,3 cases of neonatal aspiration pneumonia.There were no statistically significant differences between the two groups in terms of gestational age,birth weight,Fahrenheit score and the use of pulmonary surfactant（PS）（P>0.05）,which was comparable.3.The basic treatment of the two groups of children was the same,including warm box keeping warm,maintenance of internal environment stability,nutritional support,prevention and treatment of infection and bleeding,and the application of vasoactive drugs in some children to ensure the stability of cardiovascular function.4.Non-invasive ventilation:（1）the application of non-invasive ventilator in nHFOV group is medin-cno neonatal non-invasive high-frequency ventilator from Germany,with the output oxygen concentration range of 21%-100%,and equipped with various types of silicone nasal plugs for infants imported from the original factory.Initial parameters:mean airway pressure（MAP）8cmH₂O,frequency 9Hz,amplitude subject to chest fluctuation,inhaled oxygen concentration（FiO₂）0.4.According to blood gas analysis and percutaneous oxygen saturation regulation parameters,FiO₂ was adjusted by 0.05 each time,MAP was adjusted by 1cmH₂O each time,and frequency was adjusted by 1Hz each time.SpO₂90%-94%was maintained.Target blood gas PaO₂>was 50 mmHg,and PaCO₂<50 mmHg.When the parameters were adjusted to MAP<6cmH₂O,FiO₂<0.3,SpO₂>90%of the children without obvious apnea,the mask was changed to oxygen absorption（air oxygen mixture device controlled FiO₂<0.4,flow rate 5L/min）.（2）nCPAP group of non-invasive ventilator application using the German Stephen double nasal CPAP machine,the output oxygen concentration range of 21%to100%,with the original import of various types of infant silicone nasal plugs.Initial parameters:positive end-expiratory pressure（PEEP）5cmH₂O,flow rate 4-8L/min,inhaled oxygen concentration（FiO₂）0.4.According to blood gas analysis and percutaneous oxygen saturation adjustment parameters,FiO₂ was adjusted 0.05 at each time,PEEP was adjusted 1 cmH₂O at each time,and SpO₂90-94%was maintained.The target blood gas was the same as nHFOV group.When the parameters were reduced to PEEP<3 cmH₂O,FiO₂<0.3,SpO₂>90%of the children without obvious apnea,the mask was changed to oxygen absorption（air oxygen mixture device control FiO₂<0.4,flow rate 5L/min）.5.Monitoring indicators:0,3,12 and 24 hours oxygenation index and PH value in blood gas,oxygen partial pressure and carbon dioxide partial pressure after ventilation;Heart rate,respiration and blood pressure were routinely monitored during ventilation.The following complications were detected:pulmonary leakage,intracranial hemorrhage,necrotizing enterocolitis,ventilator-associated pneumonia.6.Statistical methods:SPSS19.0 software was used for statistical analysis of data in this study.To conform to normal distribution and the variance of the measurement data with x±s,mean differences between the two groups before and after treatment and compared by t test,expressed as a percentage of count data,component compared with chi-square test or Fisher precise probability analysis method.P<0.05 was considered statistically significant.Results1.Before the start of the treatment,children in both groups had respiratory failure,and the blood gas comparison showed no statistical significance.After the treatment,PaO₂increased in both groups,while PaCO₂ decreased.The oxygen partial pressure in nHFOV group was higher than that in nCPAP group at 3,12 and 24 hours after ventilation in different modes,and the difference of carbon dioxide depression in nCPAP group was statistically significant（P<0.05）.2.Clinical outcomes and complications:ventilation time in nHFOV group was less than that in nCPAP group,and the difference was statistically significant（P<0.05）.There were 3 cases of invasive ventilation in nHFOV group and 5 cases of invasive ventilation in nCPAP group,with no statistically significant difference（P=0.349）.There was no statistically significant difference in intracranial hemorrhage between the two groups（P=0.768）,and no pulmonary leakage,necrotizing enterocolitis,or ventilator-associated pneumonia were found in either group.ConclusionnHFOV can effectively reduce the partial pressure of carbon dioxide and increase the partial pressure of oxygen;and can shorten the time of non-invasive ventilation;and does not increase complications such as intracranial hemorrhage,pneumothorax,necrotizing enterocolitis.Therefore,nHFOV is a new safe and effective non-invasive ventilation mode with clinical value.