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

Donald Null, Jeremy Alvord, Wendy Leavitt, Albert Wint, Mar Janna Dahl, Angela P. Presson, Robert H. Lane, Robert J. Digeronimo, Bradley A. Yoder, Kurt H. Albertine

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33 Scopus citations

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 (O 2) 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 (FiO 2), 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.

Original languageEnglish (US)
Pages (from-to)507-516
Number of pages10
JournalPediatric Research
Volume75
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Null, D., Alvord, J., Leavitt, W., Wint, A., Dahl, M. J., Presson, A. P., Lane, R. H., Digeronimo, R. J., Yoder, B. A., & Albertine, K. H. (2014). High-frequency nasal ventilation for 21 d maintains gas exchange with lower respiratory pressures and promotes alveolarization in preterm lambs. Pediatric Research, 75(4), 507-516. https://doi.org/10.1038/pr.2013.254