Journal Article

Impact of different weaning strategies of high-frequency ventilation (HFV) on neonatal cerebral oxygen saturation and hemodynamics: protocol for a prospective randomized controlled trial

Shi, Jing, Chen, Chao, Zhou, Rong, Xiong, Tao, Tian, Ke, Tang, Jun, Huang, Yi, Yuan, Zhu, Zhu, Jun, Liu, Wenli, Wang, Aoyu

2024

Overview

Background High-frequency ventilation (HFV) is commonly used in neonatal intensive care units to provide respiratory support for critically ill neonates. Currently, there is no standardized procedure for weaning from HFV. Two commonly used strategies are transitioning from HFV to conventional mechanical ventilation (CMV) before extubation (HFV-CMV) and extubation after decreasing mean airway pressure during HFV (HFV-HFV). The impact of these strategies on neonatal cerebral oxygenation and hemodynamics remains incompletely understood. Methods We will conduct a prospective, single-center, randomized controlled trial to investigate the effects of two different HFV weaning strategies (HFV-CMV, HFV-HFV) on neonatal cerebral oxygenation and hemodynamics. The patients enrolled in the trial will be randomly allocated to either the HFV-CMV group or the HFV-HFV group in a 1:1 ratio. The primary outcome will be cerebral oxygen saturation (S c O 2 ) before and after the intervention. Second outcomes are cerebral fractional tissue oxygen extraction, heart rate, blood pressure, and the incidence and severity of intraventricular hemorrhage and periventricular leukomalacia. We hypothesize that HFV-CMV results in positive impact on neonatal cerebral oxygenation compared to HFV-HFV. This study aims to identify a better weaning strategy for HFV and contribute evidence-based data to enhance its clinical application in newborns, potentially improving the care and outcomes for neonates receiving HFV. Discussion This study aims to assessing the impact of different HFV weaning strategies on neonatal cerebral oxygenation and hemodynamics, as well as the relationship between the duration of HFV under different strategies and neurological complications, to identify better weaning methods for HFV. We hope to contribute evidence-based data to enhance clinical application of HFV in newborns, potentially improving the care and outcomes for neonates receiving HFV. Trial registration Chinese Clinical Trial Registry: ChiCTR2400088628. Registered on August 22, 2024, https://www.chictr.org.cn/bin/project/edit?pid=235926 .

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Airway Extubation / Analysis / Biomedicine / Birth defects / Blood pressure / Brain - metabolism / Cerebral oxygen saturation / Cerebrovascular Circulation / Clinical medicine / Clinical trials / Consent / Conventional mechanical ventilation / Education / Evidence-based medicine / Extubation / Health Sciences / Heart beat / Heart rate / Hemodynamics / Hemorrhage / High-frequency ventilation / High-Frequency Ventilation - adverse effects / High-Frequency Ventilation - methods / Hospitals / Humans / Infant, Newborn / Infants (Newborn) / Intensive Care Units, Neonatal / Medicine / Medicine & Public Health / Neonatal intensive care / Neonates / Nervous system / Newborn babies / Oxygen Saturation / Patients / Prospective Studies / Randomized Controlled Trials as Topic / Statistics for Life Sciences / Study Protocol / Time Factors / Treatment Outcome / Ventilator Weaning - methods / Ventilators / Vital signs / Wean / Weaning