Nasal high-frequency oscillation for lung carbon dioxide clearance in the newborn

Neonatology. 2013;103(3):161-5. doi: 10.1159/000345613. Epub 2012 Dec 19.


Background: Noninvasive ventilation has been used increasingly in recent years to minimize the duration of endotracheal mechanical ventilation in neonates due to its association with lung injury. Nasal high-frequency oscillation (nHFO) is a relatively new noninvasive modality but evidence for its use is limited.

Objective: The goal of this study was to compare the CO2 clearance efficacy of nHFO and noninvasive positive pressure ventilation (NIPPV) in a neonatal lung model.

Design/methods: A newborn mannequin with dimensions and anatomy similar to a term infant was utilized. It was connected to a commercially available neonatal mechanical ventilator using a manufacturer-provided nasal adaptor. Various modes of noninvasive ventilation were compared as CO2 clearance was measured at the oropharynx by an end-tidal CO2 analyzer following the addition of a known amount of CO2 into the lung. Measurements were obtained at two different lung compliances using nHFO and compared with nCMV and nasal continuous positive airway pressure (nCPAP) as a control. Pressures near the nasal adaptor and the larynx were simultaneously measured with in-line pressure transducers.

Results: Whereas no CO2 elimination was observed under nCPAP, its clearance with nHFO was 3-fold greater as compared to NIPPV. On nHFO, CO2 clearance was inversely proportional to frequency and maximal at 6 and 8 Hz. At a lower lung compliance, CO2 clearance was significantly higher at 6 Hz as compared to 10 Hz. During nHFO set to deliver a MAP of 10.0, we documented pressures of 7.2 ± 0.3 at the nasal adaptor and only 2.3 ± 0.3 cm H2O at the larynx.

Conclusions: Nasal HFO is effective and superior to NIPPV at lung CO2 elimination in a newborn mannequin model. The use of nHFO as the preferred mode of noninvasive ventilation warrants further clinical studies.

Publication types

  • Comparative Study

MeSH terms

  • Carbon Dioxide*
  • High-Frequency Ventilation / instrumentation
  • High-Frequency Ventilation / methods*
  • Humans
  • Infant, Newborn
  • Lung / physiopathology*
  • Lung Compliance
  • Manikins*
  • Positive-Pressure Respiration / instrumentation
  • Positive-Pressure Respiration / methods*
  • Pressure
  • Pulmonary Gas Exchange*
  • Transducers, Pressure
  • Ventilators, Mechanical


  • Carbon Dioxide