Discussion
respiratory failure, BPD
RESPIRATORY FAILURE, SECONDARY, RECRUITMENT
This secondary analysis of a randomized clinical trial was focused on extremely preterm neonates and those with more severe respiratory failure given their higher risk of negative outcomes. We found results similar to those reported in the whole population.The hypothesis that, in these subgroups, NHFOV would be more efficacious than the other techniques to reduce the duration of IMV is disproven. Because there are several respiratory techniques available, it is clear that there is no single solution for all patients.NHFOV seems to be associated with reduced prevalence of moderate-to-severe BPD and better postextubation gas exchange in all subgroups of interest: this might be explained with the physiology-based ventilatory approach of the NASONE trial. In fact, NHFOV was used with airway pressure higher than in the other groups and using lung recruitment maneuvers, as is usually done during invasive HFOV, without any crossover. Previous trialsWe also observed a lower incidence of apneas during NIPPV and NHFOV, consistent with what has been suggested in smaller or shorter studies.