BACKGROUND Very low birth weight (VLBW) infants on noninvasive ventilation (NIV) experience frequent fluctuations in oxygen saturation (SpO2) that are associated with an increased risk for mortality and severe morbidities. METHODS In this randomized crossover trial, VLBW infants (n = 22) born 22+3 to 28+0 weeks on NIV with supplemental oxygen were allocated on two consecutive days in random order to synchronized nasal intermittent positive pressure ventilation (sNIPPV) and nasal high-frequency oscillatory ventilation (nHFOV) for 8 h. nHFOV and sNIPPV were set to equivalent mean airway pressure and transcutaneous pCO2. Primary outcome was the time spent within the SpO2 target (88-95%). RESULTS During sNIPPV, VLBW infants spent significantly more time within the SpO2 target (59.9%) than during nHFOV (54.6%). The proportion of time spent in hypoxemia (22.3% vs. 27.1%) and the mean fraction of supplemental oxygen (FiO2) (29.4% vs. 32.8%) were significantly reduced during sNIPPV, while the respiratory rate (50.1 vs. 42.6) was significantly higher. Mean SpO2, SpO2 above the target, number of prolonged (>1 min) and severe (SpO2 <80%) hypoxemic episodes, parameters of cerebral tissue oxygenation using NIRS, number of FiO2 adjustments, heart rate, number of bradycardias, abdominal distension and transcutaneous pCO2 did not differ between both interventions. CONCLUSIONS In VLBW infants with frequent fluctuations in SpO2, sNIPPV is more efficient than nHFOV to retain the SpO2 target and to reduce FiO2 exposure. These results demand more detailed investigations into cumulative oxygen toxicities during different modes of NIV over the weaning period, particularly with regard to consequences for long-term outcomes.

中文翻译：

---

极低出生体重婴儿同步鼻间歇正压通气和鼻高频振荡通气期间的氧饱和度波动：随机交叉试验。

背景 使用无创通气 (NIV) 的极低出生体重 (VLBW) 婴儿的血氧饱和度 (SpO2) 会频繁波动，这与死亡和严重发病风险增加相关。方法 在这项随机交叉试验中，出生于 22+3 至 28+0 周、接受 NIV 补充供氧的 VLBW 婴儿 (n = 22) 连续两天随机分配至同步经鼻间歇正压通气 (sNIPPV) 和经鼻高压通气-频率振荡通气（nHFOV）8小时。nHFOV 和 sNIPPV 设置为等效平均气道压和经皮 pCO2。主要结果是在 SpO2 目标范围内花费的时间 (88-95%)。结果 在 sNIPPV 期间，VLBW 婴儿达到 SpO2 目标的时间 (59.9%) 比 nHFOV 期间 (54.6%) 明显更长。sNIPPV 期间，低氧血症时间比例（22.3% vs. 27.1%）和平均吸氧分数（FiO2）（29.4% vs. 32.8%）显着降低，而呼吸频率（50.1 vs. 42.6）则显着降低。明显更高。平均 SpO2、SpO2 高于目标值、长时间（>1 分钟）和严重（SpO2 <80%）低氧血症发作次数、使用 NIRS 的脑组织氧合参数、FiO2 调整次数、心率、心动过缓次数、腹胀和两种干预措施之间的经皮 pCO2 没有差异。结论 对于 SpO2 频繁波动的 VLBW 婴儿，sNIPPV 比 nHFOV 更能有效地保持 SpO2 目标并减少 FiO2 暴露。这些结果需要对断奶期间不同 NIV 模式下的累积氧毒性进行更详细的调查，特别是对长期结果的影响。