High-Frequency Oscillatory Ventilation (HFOV) in preterm infants: Nursing management experience of a III-level Neonatal Intensive Care Unit (NICU) at the Catholic University of the Sacred Heart of Rome
Bibliographic record
Abstract
Background: During the last years High Frequency Oscillatory Ventilation (HFOV) has been increasingly used in preterm infants with respiratory failure. In our Neonatal Intensive Care Unit (NICU) newborns with gestational age (GA) ≤ 27 weeks and/or birth weight (BW) < 1000g requiring mechanical ventilation, are electively treated with HFOV, performed with Draeger Babylog 8000 plus. Specific knowledge regarding optimal methods for setting and managing HFOV involves both physicians and nurses. Nursing considerations for the use of HFOV to detect changes in condition and to prevent complications in a high risk population, such as patients of NICU, are strongly needed. Furthermore data on weaning and extubation criteria are limited, especially in extremely low birth weight (ELBW) infants. Objective of this study was to evaluate the HFOV major nursing issues in the light of a more than ten years’ experience in the management of preterm infants (GA ≤ 27 weeks) and/or BW < 1000g who require invasive respiratory assistance and managed with HFOV as a primary mode of ventilation. Methods: We described some key points of nursing care of preterm infants HFOV ventilated: airways, circulation, care, postures and patients comfort. All preterm infants directly extubated from HFOV between June 2006 and June 2009 were included into this retrospective cohort study. Extubation was attempted when continuous distending pressure (CDP) was ≤ 6 cmH 2 O, FiO 2 ≤ 0.25 and Amplitude ≤ 30%. Data on ventilator setting and gas exchange parameters just prior to extubation were collected by reviewing respiratory sheets. Results : Fifty-eight patients of 73 electively treated with HFOV (79.5%) were directly extubated from HFOV: 53 (91%) were successfully extubated and 5 (9%) required re-intubation within the following 72 hours for hypercapnia (pCO 2 > 70 mmHg). No significant differences were found between Extubation Success and Extubation Failure Groups in terms of GA (26.2 ± 1.3 vs 25.8 ± 1.3 weeks, respectively), BW (770 ± 204 vs 614 ± 193g, respectively), day of extubation (3 [1-53] vs 3 [2-10], respectively). The only different parameter between Extubation Success and Extubation Failure Groups was DCO 2 (Vt 2 xHz/kg) before extubation, significantly higher in the first Group: 30 ± 10 vs 18 ± 12 ( p <0.05). Conclusions: In electively HFOV ventilated ELBW infants, weaning the CDP ≤ 6 cmH 2 O with FiO 2 ≤ 0.25 is feasible and extubation at this setting is successful in 91% of our ELBW infants.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".