الفهرس 
RESPIRATORY DISTRESS SYNDROMEOnly 14 pages are availabe for public view
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Abstract
W
eaning from mechanical ventilation is a crucial stage and sincere efforts should be applied to ensure its success. Weaning success is significantly affected by choosing an efficient and safe post-extubation noninvasive modality and choosing the optimal time for weaning based on accurate prediction of extubation outcome.
NHFOV is a relatively new form of noninvasive respiratory support. This mode aims to merge the gentleness of noninvasive ventilation with the efficiency of high-frequency ventilation.
This study‘s primary aim was to compare the novel noninvasive modality NHFOV with the commonly used NIPPV as respiratory support after extubation in preterm neonates with RDS.
The secondary aim was to assess the use of LUS to predict extubation outcome and choose the optimal time for extubation.
This study was a randomized controlled trial conducted in the period from January 2021 to July 2022 in the NICU of Children’s Hospital Ain Shams University, Cairo, Egypt. The study was approved by the Research Ethics Committee of the faculty of medicine, Ain Shams University. Informed written consent was taken before enrolment from the parents or legal guardians.
This study was conducted on 60 preterm neonates (gestational age less than or equal to 35 weeks) diagnosed with RDS and ventilated for more than 48 hours. Preterm neonates with inborn errors of metabolism, congenital malformations, neonates needing surgical intervention and those whose guardians refused to participate were excluded.
The patients were randomized at the time of extubation and allocated into one of 2 groups: the NIPPV group and the NHFOV group as post-extubation noninvasive respiratory support.
All studied preterm neonates were subjected to perinatal history, clinical examination and standard neonatal care. The gestational age, APGAR score at 1 and 5 minutes, administration of surfactant and caffeine citrate, duration of invasive respiratory support and pre-extubation ventilation settings were recorded together with the anthropometric measurements.
Daily inspection of infants’ nostrils to evaluate the presence of nasal trauma was done. Nasal trauma was classified as Grade I (persitent non-blanching hyperemia), Grade II (superficial ulcer), or Grade III (necrosis and tissue loss).
Venous blood gases and Downe’s score were assessed pre-extubation and 2 hours post-extubation.
Lung Ultrasound examination and LUS calculation were performed before and 2 hours post-extubation for all patients using UGEO HM70A; SAMSUNG ELECTRONICS and a linear high-frequency probe (12 MHz).
The primary outcome was comparison of the rate of re-intubation within 72 hours post-extubation between NIPPV and NHFOV in preterm neonates with RDS.
Secondary outcomes included a comparison between the 2 groups regarding Oxygen needs, duration of the used noninvasive modality, duration of admission, mortality rate, and safety of the used noninvasive modality (Incidence of nasal trauma, air leak, BPD, feeding intolerance and intracranial hemorrhage)
The two groups were matched regarding neonatal characteristics (Gestational age, birth weight, administration of surfactant, caffeine citrate and antenatal steroids) and invasive ventilation duration before extubation. The two groups were also matched regarding age, weight, administration of cardiac supports and presence of sepsis at the time of extubation.
Re-intubation rate was lower in the NHFOV group (23.3%) compared to the NIPPV group (30.0%) however, this difference wasn’t statistically significant. Oxygen needs were significantly lower in the NHFOV group (mean 31.80 ± 6.09) compared to the NIPPV group (mean 38.00 ± 10.55) with a p-value of 0.007.
Difference between the two groups regarding noninvasive mode duration, mortality rate, PH values, and CO2 values were statistically insignificant (P-value > 0.05) however, a trend for better results were seen in the NHFOV group regarding Co2 clearance and total duration of admission.
Both groups were equally safe regarding the incidence of intracranial hemorrhage, pneumothorax, nasal trauma, feeding intolerance and BPD in survivors (P-value > 0.05).
The pre-extubation LUS was significantly higher in patients with extubation failure with a median10 compared to patients with extubation success with a median of 4.5 with p value 0.000.
Also, The LUS performed 2 hours post-extubation was significantly higher in patients with extubation failure median of 14 compared to patients with extubation success median of 6 with a p-value of 0.000.
LUS was significantly correlated to extubation outcome, the higher the LUS the higher the risk of extubation failure.
LUS were compared between the 2 noninvasive modalities. No statistically significant difference was found with p-value > 0.005.
CONCLUSION
N
HFOV is a promising post-extubation noninvasive modality for neonates. Patients on NHFOV showed significantly lower oxygen requirements and a slightly lower incidence of extubation failure. It is equally safe as the conventionally used noninvasive modality NIPPV.
LUS is an excellent predictor of extubation outcome in neonates and we encourage its use as a reliable assistant in the decision making of extubation.