Haemodynamic Changes with Different Noninvasive Respiratory Modes for Primary Respiratory Support in Preterm Neonates

Abstract

Abstract Background Nasal continuous positive airway pressure (CPAP) is frequently used to support preterm infants with respiratory distress syndrome. Little is known about other modes of Non invasive ventilation, including Nasal high frequency (NHFOV) and Vapotherm, and the hemo- dynamic changes that occur, particularly during the weaning phase when lung compliance has improved. Objectives This study aimed to assess the efficacy of NHFOV and Vapotherm in comparison to CPAP as a primary noninvasive respiratory support in preterm neonates and the haemodynamic changes that occur during periods of non-invasive respiratory support including echocardiographic, cerebral and mesenteric blood flow changes. Methods We conducted a randomized controlled study on 90 preterm infants (gestational age≤35 weeks) with respiratory distress syndrome, 30 preterms were receiving NHFOV delivered by; SLE 6000 device, Amplitude range (20:35)cm H2O, frequency range (8-12)HZ, Mean air way pressure (MAP) range (6: 10) cmH2O and I:E ratio 1:1, 30 preterms receiving Vapotherm, delivered by; Vapotherm device, with flow rate 4-8L/min, temperature 36-37 °C and Fractionated inspired oxygen (FiO2) titrated as needed to achieve target Oxygen Saturation (SpO2)(90% to 94%) using soft nasal cannula interface and 30 preterms receiving CPAP delivered by; MEDIN CNO device, Pressure ranging from 5 to 8 cm H2O, to maintain SpO2 from 90% to 94% using bi-nasal with midline prongs. All included preterms were subjected to detailed antenatal, natal and postnatal history, clinical examination including vital signs, recording medications received, any complications that occurred, duration of hospital admission and the type of noninvasive ventilation received. While being on noninvasive ventilation and one hour after weaning, all included preterms were subjected to a 2-dimensional M-mode, pulsed Doppler echocardiography to assess Right ventricular output(RVO), Left ventriculat output (LVO) and Superior vena cava (SVC) flow, Transcranial and Pelviabdominal ultrasound to assess Anterior cerebral artery resistive index (ACA RI) and Superior mesenteric artery resistive index (SMA RI). Results A total of 90 preterm infant were studied. As regard treatment failure rate, in NHFOV group, 8 of 30 (26.7%) preterm infants showed treatment failure and required Invasive mechanical ventilation (IMV). In Vapotherm group 17 of 30 (56.6%) preterm infant had treatment failure and required IMV, while 16 of 30 (53.3%) preterm infants showed treatment failure and required IMV in nasal CPAP group. In CPAP group, LVO significantly increased while ACA RI decreased After weaning (P = 0.000,0.012) respectively. In vapothrrm group, RVO, LVO, ACA RI and SMA RI significantly decreased after weaning (P = 0.017, 0.003, 0.001, 0.016) respectively. In NHFOV group, RVO and SVC flow significantly decreased after weaning (P = 0.004, 0.014) respectively. CPAP group exhibited a significantly higher percentage change in LVO compared to the NHFOV and vapotherm groups (24.23vs0 vs 15.23 respectively). Conclusions The Failure rate and need for IMV rate was significantly lower in the NHFOV group compared to Vapotherm and NCPAP, CPAP group exhibited a significantly higher percentage change in LVO compared to the NHFOV and vapotherm groups.