Transmission of Oscillatory Volumes into the Preterm Lung during Noninvasive High-Frequency Ventilation

• DOI: 10.1164/rccm.202007-2701oc
• Publication Date: 2020-10-23T21:14:16Z
• Authors: Vincent D. Gaertner; Andreas D. Waldmann; Peter G. Davis; Dirk Bassler; Laila Springer; Jessica Thomson; David G. Tingay; Christoph M. Rüegger
• Keywords: Pulmonary and Respiratory Medicine; Male; Respiratory Distress Syndrome, Newborn; Cross-Over Studies; Noninvasive Ventilation; noninvasive high; Continuous Positive Airway Pressure; Infant, Newborn; 610; High-Frequency Ventilation; 600; 610 Medicine & health; 10027 Clinic for Neonatology; Critical Care and Intensive Care Medicine; infant; 03 medical and health sciences; 0302 clinical medicine; Forced Expiratory Volume; frequency oscillatory ventilation; Humans; Female; Infant, Premature; electrical impedance tomography

Rationale: There is increasing evidence for a clinical benefit of noninvasive high-frequency oscillatory ventilation (nHFOV) in preterm infants. However, it is still unknown whether the generated oscillations are effectively transmitted to the alveoli.Objectives: To assess magnitude and regional distribution of oscillatory volumes (VOsc) at the lung level.Methods: In 30 prone preterm infants enrolled in a randomized crossover trial comparing nHFOV with nasal continuous positive airway pressure, electrical impedance tomography recordings were performed. During nHFOV, the smallest amplitude to achieve visible chest wall vibration was used, and the frequency was set at 8 hertz.Measurements and Main Results: Thirty consecutive breaths during artifact-free tidal ventilation were extracted for each of the 228 electrical impedance tomography recordings. After application of corresponding frequency filters, Vt and VOsc were calculated. There was a signal at 8 and 16 Hz during nHFOV, which was not detectable during nasal continuous positive airway pressure, corresponding to the set oscillatory frequency and its second harmonic. During nHFOV, the mean (SD) VOsc/Vt ratio was 0.20 (0.13). Oscillations were more likely to be transmitted to the non-gravity-dependent (mean difference [95% confidence interval], 0.041 [0.025-0.058]; P < 0.001) and right-sided lung (mean difference [95% confidence interval], 0.040 [0.019-0.061]; P < 0.001) when compared with spontaneous Vt.Conclusions: In preterm infants, VOsc during nHFOV are transmitted to the lung. Compared with the regional distribution of tidal breaths, oscillations preferentially reach the right and non-gravity-dependent lung. These data increase our understanding of the physiological processes underpinning nHFOV and may lead to further refinement of this novel technique.