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Non-invasive high-frequency oscillatory ventilation in preterm infants: a randomised controlled cross-over trial
  1. Daniel Klotz1,
  2. Hendryk Schneider1,
  3. Stefan Schumann2,
  4. Benjamin Mayer3,
  5. Hans Fuchs1
  1. 1 Department of Neonatology, Center for Pediatrics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  2. 2 Department of Anesthesiology and Critical Care, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  3. 3 Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
  1. Correspondence to Dr Daniel Klotz, Department of Neonatology, Center for Pediatrics, Medical Center—University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; daniel.klotz{at}


Objective Non-invasive high-frequency oscillatory ventilation (nHFOV) has recently been described as a novel mode of respiratory support for premature infants. This study was designed to determine whether nHFOV decreases CO2 partial pressure (pCO2) in premature infants more effectively than non-invasive continuous positive airway pressure (nCPAP).

Design Non-blinded prospective randomised controlled cross-over study.

Setting University Medical Center tertiary neonatal intensive care unit.

Patients 26 premature infants of 27±2 weeks of gestational age after extubation or non-invasive surfactant treatment.

Interventions Infants were treated with 4 hours of nHFOV and 4 hours of nCPAP in a cross-over design. The sequence of the ventilation mode was randomly allocated.

Main outcome measures The primary outcome measure was pCO2 of arterial or arterialised blood 4 hours after commencing the respective mode of respiratory support. Secondary outcome criteria included events of apnoea and bradycardia, respiratory rate, heart rate, pain and/or discomfort, mean airway pressure, fraction of inspired oxygen and failure of non-invasive respiratory support.

Results pCO2 after 4 hours of nHFOV was similar compared with 4 hours of nCPAP (p=0.33). pCO2 was 54.8 (14.6) vs 52.7 (9.3) mm Hg mean (SD) for the nHFOV–nCPAP period (n=13) and 49.0 (8.1) vs 47.7 (9.5) mm Hg for the nCPAP–nHFOV period (n=13). There was no difference in any of the secondary outcome measures. nHFOV was terminated prematurely in five cases for predefined failure criteria (p=0.051).

Conclusions We could not demonstrate an increased carbon dioxide clearance applying nHFOV compared with nCPAP in this cohort of preterm infants.

Trial registration number DRKS00007171, results.

  • non-invasive ventilation
  • high frequency oscillatory ventilation
  • preterm
  • neonate
  • carbon dioxide

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  • Contributors DK conceived and designed the study, collected and analysed data, and wrote the first draft of the manuscript. HS contributed to data collection and reviewed the manuscript. BM analysed data and reviewed the manuscript. SS reviewed and edited the manuscript. HF contributed to study design, contributed in data collection and analysis, and edited the manuscript.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Ethics Committee of the University of Freiburg, Freiburg, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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