Noninvasive High-Frequency Ventilation Versus Classical Ventilation Modalities as Postextubation Support in Preterm Infants: A Systematic Review

Abstract

Aim: This study is aimed at determining whether noninvasive high-frequency oscillatory ventilation (NHFOV) is more effective than nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) in reducing the need for invasive mechanical ventilation (IMV) after the first extubation in preterm infants ≤ 33 weeks of gestational age.

Methods: This work is a systematic review of randomized controlled clinical trials in the last 6 years. The databases utilized were PubMed, Cochrane, and Scopus.

Results: Analysis showed that the reintubation rate (RR) was significantly higher in the NCPAP group compared with NHFOV and NIPPV in all included studies analyzing this comparison. When comparing NHFOV and NIPPV, most studies showed no significant difference. In terms of effectiveness, NIPPV and NHFOV were associated with superior gas exchange efficiency after extubation and shorter duration of IMV and hospital stay compared with NCPAP. NHFOV appears to be associated with a lower incidence of moderate-to-severe bronchopulmonary dysplasia than NCPAP.

Conclusion: In very preterm newborns, NHFOV and NIPPV are associated with a lower RR and shorter duration of ventilation compared with NCPAP. NHFOV also demonstrates better postextubation results compared with NCPAP. Further studies evaluating NHFOV in neonatal intensive care units are needed to confirm its generalizability.