• Christoph Czernik, Gerd Schmalisch, Christoph Bührer, and Hans Proquitté.
• Department of Neonatology, Charité University Medical Center, Berlin, Germany. christoph.czernik@charite.de
• J. Matern. Fetal. Neonatal. Med. 2012 Apr 1; 25 (4): 374-8.

ObjectiveTo investigate the feasibility of nasopharyngeal high-frequency oscillatory ventilation (nHFOV) immediately after extubation in difficult-to-wean preterm infants.Study DesignThis was an observational study of 20 mechanically ventilated neonates [median (range) birth weight 635 (382-1020)g, median gestational age 25.3 (23.7-27.6) weeks] at high risk for extubation failure. Nine infants had failed at least one previous extubation. Fourteen infants were given hydrocortisone. All 20 infants were extubated into nHFOV, with a mean airway pressure of 8 cmH(2)O, an amplitude of 20 cmH(2)O, and a frequency of 10 Hz.Results Infants remained on nHFOV for a median duration of 136.5 (7.0-456.0) h until further weaning to continuous positive airway pressure (n =14) or reintubation (n = 6). Reintubation was performed in 1 of 11 infants who had not experienced any previous extubation, and in five of nine infants who had experienced at least one previous extubation (P < 0.05). PaCO(2) was virtually unchanged from preextubation levels 2 h after extubation, but declined significantly at 32 h from 59.8 (45.0-92.3) mmHg to 50.7 (39.8-74.4) mmHg (P < 0.01). PaCO(2) returned to preextubation levels upon discontinuation of nHFOV.ConclusionThis small observational study demonstrates that nHFOV can be successfully applied to wean premature infants from ventilator support.

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