High-Frequency Oscillatory Ventilation (HFOV) in preterm infants: Nursing management experience of a III-level Neonatal Intensive Care Unit (NICU) at the Catholic University of the Sacred Heart of Rome

Abstract

Background: During the last years High Frequency Oscillatory Ventilation (HFOV) has been increasingly used in preterm infants with respiratory failure. In our Neonatal Intensive Care Unit (NICU) newborns with gestational age (GA) ≤ 27 weeks and/or birth weight (BW) < 1000g requiring mechanical ventilation, are electively treated with HFOV, performed with Draeger Babylog 8000 plus. Specific knowledge regarding optimal methods for setting and managing HFOV involves both physicians and nurses. Nursing considerations for the use of HFOV to detect changes in condition and to prevent complications in a high risk population, such as patients of NICU, are strongly needed. Furthermore data on weaning and extubation criteria are limited, especially in extremely low birth weight (ELBW) infants. Objective of this study was to evaluate the HFOV major nursing issues in the light of a more than ten years’ experience in the management of preterm infants (GA ≤ 27 weeks) and/or BW < 1000g who require invasive respiratory assistance and managed with HFOV as a primary mode of ventilation.

Methods: We described some key points of nursing care of preterm infants HFOV ventilated: airways, circulation, care, postures and patients comfort. All preterm infants directly extubated from HFOV between June 2006 and June 2009 were included into this retrospective cohort study. Extubation was attempted when continuous distending pressure (CDP) was ≤ 6 cmH₂O, FiO₂ ≤ 0.25 and Amplitude ≤ 30%. Data on ventilator setting and gas exchange parameters just prior to extubation were collected by reviewing respiratory sheets.

Results: Fifty-eight patients of 73 electively treated with HFOV (79.5%) were directly extubated from HFOV: 53 (91%) were successfully extubated and 5 (9%) required re-intubation within the following 72 hours for hypercapnia (pCO₂> 70 mmHg). No significant differences were found between Extubation Success and Extubation Failure Groups in terms of GA (26.2 ± 1.3 vs 25.8 ± 1.3 weeks, respectively), BW (770 ± 204 vs 614 ± 193g, respectively), day of extubation (3 [1-53] vs 3 [2-10], respectively). The only different parameter between Extubation Success and Extubation Failure Groups was DCO₂ (Vt²xHz/kg) before extubation, significantly higher in the first Group: 30 ± 10 vs 18 ± 12 (p<0.05).

Conclusions: In electively HFOV ventilated ELBW infants, weaning the CDP ≤ 6 cmH₂O with FiO₂ ≤ 0.25 is feasible and extubation at this setting is successful in 91% of our ELBW infants.