Non-invasive high-frequency ventilation versus bi-phasic continuous positive airway pressure (BP-CPAP) following CPAP failure in infants <1250 g: a pilot randomized controlled trial

Objective:non-invasive high-frequency ventilation (nihfv), a relatively new modality, is gaining popularity despite limited data. we sought to evaluate the effectiveness of nihfv versus bi-phasic continuous positive airway pressure (bp-cpap) in preterm infants failing cpap.study design:infants with bw<1250 g on cpap were randomly assigned to nihfv or bp-cpap if they met pre-determined criteria for cpap failure. infants were eligible for randomization after 72 h age and until 2000 g. guidelines for adjustment of settings and criteria for failure of assigned mode were implemented. the primary aim was to assess feasibility of a larger trial. in addition, failure of assigned non-invasive respiratory support (nrs) mode, invasive mechanical ventilation (mv) 72 h and 7 days post-randomization, and bronchopulmonary dysplasia (bpd) were assessed.results:thirty-nine infants were randomized to nihfv (n=16) or bp-cpap (n=23). there were no significant differences in mean (s.d.) postmenstrual age (28.6 (1.5) versus 29.0 (2.3) weeks, p=0.47), mean (s.d.) weight at randomization (965.0 (227.0) versus 958.1 (310.4) g, p=0.94) or other baseline demographics between the groups. failure of assigned nrs mode was lower with nihfv (37.5 versus 65.2%, p=0.09), although not statistically significant. there were no differences in rates of invasive mv 72 h and 7 days post-randomization or bpd.conclusion:nihfv was not superior to bp-cpap in this pilot study. effectiveness of nihfv needs to be proven in larger multi-center, appropriately powered trials before widespread implementation.