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High-frequency oscillatory ventilation with or without volume guarantee during neonatal transport

Journal of Perinatology volume 45, pages 43–49 (2025)Cite this article

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Abstract

Objectives

To analyse deviation of ventilator parameters from their set targets during high-frequency oscillatory ventilation (HFOV) with or without volume guarantee (VG) and compare the two modes during emergency neonatal transport.

Study design

Retrospective observational study using the fabian™ HFOi ventilator.

Results

Median deviation of mean airway pressure from the set value was <1 cmH2O. During HFOV the pressure amplitude differed from the set value by <1 cmH2O. During HFOV-VG median deviation of the oscillation volume (VThf) from the targeted value was −0.07 mL/kg, but in some cases VThf was by >0.38 mL/kg below target. Setting maximum allowed amplitude 10 cmH2O above the usually required amplitude improved maintenance of VThf. HFOV and HFOV-VG parameters were similar, except the lower amplitude during HFOV without VG. VThf <2.5 mL/kg avoided hypercapnia in most cases.

Conclusions

HFOV and HFOV-VG maintain ventilator parameters close to their targets and are promising modalities during neonatal transport.

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Fig. 1: Delivery of the targeted oscillation volume during HFOV-VG is dependent on setting of the maximum allowed pressure amplitude.
Fig. 2: Mean airway pressure (MAP), fraction of inspired oxygen (FiO2) and blood gases in infants ventilated with HFOV during transport.
Fig. 3: Relationship between oscillation volumes, diffusion coefficients of carbon dioxide and blood CO2 levels.

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Data availability

Notebooks containing the Python code and explaining all steps of data processing and analysis have been uploaded to a GitHub code repository and are available at https://github.com/belteki/transport_HFOV. Ventilator data are available from the corresponding author upon reasonable request and subject to research ethics committee approval.

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Acknowledgements

We thank to Rainer Kühner (Vyaire) for help with exporting data from the fabian™ HFOi ventilator.

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Authors and Affiliations

  1. Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary

    Vera Balog, Gabor Liszkay, Lajos Lantos & Gusztav Belteki

  2. Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary

    Vera Balog & Agnes Jermendy

  3. Bethesda Children’s Hospital, Budapest, Hungary

    Gabor Liszkay

  4. Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Gusztav Belteki

Authors
  1. Vera Balog
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  2. Gabor Liszkay
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  3. Lajos Lantos
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  4. Agnes Jermendy
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  5. Gusztav Belteki
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Contributions

VB participated in the conception of the study, collected clinical information, participated in the interpretation of results, and edited the manuscript. GL participated in the interpretation of results and edited the manuscript. LL participated in the acquisition and interpretation of clinical data and revising the article. AJ participated in the interpretation of clinical data and revising the article. GB was responsible for the conception of the study, statistical analysis, and interpretation of data, and wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gusztav Belteki.

Ethics declarations

Competing interests

Gusztav Belteki is a consultant to Vyaire Medical (Mettawa, IL, US) and Dräger Medical (Lübeck, Germany). Vyaire Medical did not ask the authors to perform the study or participate in it and did not provide any payment for it.

Ethics approval and consent to participate

The study was approved by the Scientific and Medical Research Council Ethics Committee of Hungary (reference40158-2/2018:/EKU). All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983.

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Balog, V., Liszkay, G., Lantos, L. et al. High-frequency oscillatory ventilation with or without volume guarantee during neonatal transport. J Perinatol 45, 43–49 (2025). https://doi.org/10.1038/s41372-024-02109-9

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