This study aims to evaluate the relationship between ventilator-derived carbon dioxide clearance and arterial CO2 elimination during high-frequency oscillatory ventilation with volume guarantee (HFOV-VG), and to examine determinants and clinical relevance of ventilatory efficiency. In this cohort study, preterm infants less than 30 weeks of gestation receiving HFOV-VG were studied during the first 72 h after birth. Minute-level ventilator data were paired with arterial blood gases. Ventilatory efficiency was defined as weight-normalised DCO2 divided by arterial PCO2. Temporal patterns and determinants were analysed using generalised estimating equations. The clinical outcome was death or moderate-to-severe bronchopulmonary dysplasia (BPD). A total of 185,018 ventilator observations and 595 paired ventilator–blood gas measurements from 60 infants were analysed. Arterial PCO2 remained stable (50 [43–56] mmHg) despite wide variation in DCO2 (34.6 [27.1–47.8]). Ventilatory efficiency varied between infants (0.72 [0.55–0.98]) and demonstrated a temporal pattern, decreasing from 0.77 (0.61–0.90) at 0–6 h to 0.65 (0.45–0.80) at 6–12 h and increasing to 0.76 (0.56–1.07) at 24–48 h. Higher efficiency was associated with higher oscillatory frequency (p < 0.001). Death or moderate-to-severe BPD occurred in 85.0%, 70.0%, and 45.0% across low, intermediate-, and high-efficiency tertiles, respectively. Ventilatory efficiency demonstrated moderate discrimination for the composite outcome (AUC 0.69), improving to 0.76 with FiO2 and mean airway pressure. Conclusion: During HFOV-VG, ventilator-derived CO2 clearance showed limited correspondence with arterial PCO2. Ventilatory efficiency had moderate discrimination for adverse respiratory outcomes. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> What is Known: • During high-frequency oscillatory ventilation, ventilator-derived indices such as oscillatory tidal volume and DCO2 are commonly used to guide carbon dioxide clearance. • The relationship between ventilator-derived carbon dioxide transport and effective arterial CO2 elimination during HFOV with volume guarantee remains incompletely understood. </entry> </row> <row> <entry nameend="c2" namest="c1"> What is New: • Ventilatory efficiency provides a physiological measure integrating ventilator-derived carbon dioxide transport and arterial CO2 elimination during HFOV with volume guarantee, a relationship that is not routinely evaluated in clinical practice. • Ventilatory efficiency demonstrated modest discrimination for death or moderate-to-severe bronchopulmonary dysplasia, with discrimination improving when combined with markers of respiratory support intensity. </entry> </row> </tbody> </tgroup> </Table>

Ventilatory efficiency during high-frequency oscillatory ventilation with volume guarantee in preterm infants

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2026年6月26日

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Kamal Ali,
Mesaed Alsenani,
Saad Alshareedah,
Faisal Alamer,
Piero Alberti,
Abdulaziz Homedi,
Saif Alsaif,
Ibrahim Ali,
Theodore Dassios,
Anne Greenough

摘要

This study aims to evaluate the relationship between ventilator-derived carbon dioxide clearance and arterial CO₂ elimination during high-frequency oscillatory ventilation with volume guarantee (HFOV-VG), and to examine determinants and clinical relevance of ventilatory efficiency. In this cohort study, preterm infants less than 30 weeks of gestation receiving HFOV-VG were studied during the first 72 h after birth. Minute-level ventilator data were paired with arterial blood gases. Ventilatory efficiency was defined as weight-normalised DCO₂ divided by arterial PCO₂. Temporal patterns and determinants were analysed using generalised estimating equations. The clinical outcome was death or moderate-to-severe bronchopulmonary dysplasia (BPD). A total of 185,018 ventilator observations and 595 paired ventilator–blood gas measurements from 60 infants were analysed. Arterial PCO₂ remained stable (50 [43–56] mmHg) despite wide variation in DCO₂ (34.6 [27.1–47.8]). Ventilatory efficiency varied between infants (0.72 [0.55–0.98]) and demonstrated a temporal pattern, decreasing from 0.77 (0.61–0.90) at 0–6 h to 0.65 (0.45–0.80) at 6–12 h and increasing to 0.76 (0.56–1.07) at 24–48 h. Higher efficiency was associated with higher oscillatory frequency (p < 0.001). Death or moderate-to-severe BPD occurred in 85.0%, 70.0%, and 45.0% across low, intermediate-, and high-efficiency tertiles, respectively. Ventilatory efficiency demonstrated moderate discrimination for the composite outcome (AUC 0.69), improving to 0.76 with FiO₂ and mean airway pressure. Conclusion: During HFOV-VG, ventilator-derived CO₂ clearance showed limited correspondence with arterial PCO₂. Ventilatory efficiency had moderate discrimination for adverse respiratory outcomes.

What is Known:

• During high-frequency oscillatory ventilation, ventilator-derived indices such as oscillatory tidal volume and DCO2 are commonly used to guide carbon dioxide clearance.

• The relationship between ventilator-derived carbon dioxide transport and effective arterial CO2 elimination during HFOV with volume guarantee remains incompletely understood.

What is New:

• Ventilatory efficiency provides a physiological measure integrating ventilator-derived carbon dioxide transport and arterial CO2 elimination during HFOV with volume guarantee, a relationship that is not routinely evaluated in clinical practice.

• Ventilatory efficiency demonstrated modest discrimination for death or moderate-to-severe bronchopulmonary dysplasia, with discrimination improving when combined with markers of respiratory support intensity.