Effects of Short Versus Prolonged Inspiratory Times on Oxygen Saturation Targeting in Very Low Birth Weight Infants During Synchronized NIPPV

Background Effects of different inspiratory times during synchronized NIPPV on oxygen saturation targeting, intermittent SpO 2 ‐fluctuations and cerebral tissue oxygen saturation (SctO 2 ) are unknown. Objective To assess effects of different inspiratory times during NIPPV on SpO 2 and SctO 2 parameters in very low birth weight infants with frequent fluctuations in SpO 2 . Study Design Twenty‐four infants (gestational age: 25 [22–28] weeks; postnatal age: 27 [12–85] days) were randomly exposed in a cross‐over‐design to NIPPV with prolonged (NIPPV Tilong ; 0.6 s) and short inspiratory time (NIPPV Tishort ; 0.3 s) over 8 h each. Primary outcome was the percentage of time spent within the SpO 2 target range (88%–95% and ≥ 88% with FiO 2 0.21). Secondary oxygenation outcomes included area under the curve (AUC) above and below a predefined SctO 2 ‐range and number of SpO 2 ‐desaturation events. Results Percentage of time within SpO 2 target range significantly increased during NIPPV Tilong (66.41% ± 12.76 vs. 60.33% ± 15.28, p = 0.02). Episodes with SpO 2 < 88%, duration > 180 s (0.1/h [0.0–0.9] vs. 0.2/h [0.0–1.3], p = 0.04) and episodes with SpO 2 < 80%, duration > 180 s (0.0/h [0.0–0.1] vs. 0.2/h [0.0–0.4], p = 0.03) significantly decreased during NIPPV Tilong . The AUC with SctO 2 ‐desaturations below the cerebral SctO 2 ‐threshold was reduced during NIPPV Tilong (29.75 (%*s)/h [0.0–1283.44] vs. 71.08 (%*s)/h [0.0–1474.96], p = 0.03). Conclusion NIPPV Tilong increased the time within an SpO 2 target range, reduced the incidence of prolonged hypoxemic events and cerebral hypoxia burden. Extending the inspiratory time during synchronized NIPPV may have short‐term benefits in unstable infants with SpO 2 fluctuations.