Temporal Dynamics and Clinical Relevance of Oscillatory Amplitude Variability During High-Frequency Oscillatory Ventilation With Volume Guarantee in Preterm Infants
In brief
Early ventilator variability moderately predicted poor outcomes in 60 preterm infants
In this single-center study, early oscillatory amplitude variability distinguished infants who died before discharge or developed moderate-to-severe lung disease with moderate accuracy; the combined outcome occurred in 47 of 60 infants. Accuracy rose when variability was combined with ventilation frequency and a weight-adjusted measure of carbon dioxide removal, but the small study needs independent validation before clinical use.
- Journal
- Pediatric pulmonology (Q1)
- Published
- 1 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Kamal Ali, Mesaed Alsenani, Saad Alshareedah, Mohamed Sufyani, Saleh Algarni, Piero Alberti, et al.
- PMID
- 42829884
- DOI
- 10.1002/ppul.71859
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 7 October 2026): Oscillatory amplitude variability predicts BPD outcomes
Abstract
OBJECTIVE: To characterise temporal dynamics, variance structure, determinants, and predictive relevance of oscillatory amplitude variability during high-frequency oscillatory ventilation with volume guarantee (HFOV-VG) in preterm infants. METHODS: Single-centre retrospective cohort study using minute-level ventilator data collected during the first 72 h of HFOV-VG. Amplitude variability was quantified using standard deviation, coefficient of variation (CV), and root mean square of successive differences (RMSSD). Temporal patterns, variance decomposition, and determinants of variability were assessed using mixed-effects modelling separating within- and between-infant effects. Predictive performance for death before discharge or moderate-to-severe bronchopulmonary dysplasia was evaluated using receiver operating characteristic analysis. RESULTS: A total of 237,790 measurements from 60 infants were analysed. Amplitude CV declined from 0.122 (0.072-0.160) at 0-6 h to 0.063 (0.035-0.106) at 48-72 h, while RMSSD decreased from 2.10 (1.22-2.69) to 1.13 (0.64-1.94). Variability was predominantly within-infant (ICC 0.246-0.282), whereas mean amplitude, VThf/kg, and frequency were predominantly between-infant. Within-infant increases in oscillatory frequency were associated with higher variability, whereas increases in mean airway pressure and time from HFOV initiation were associated with lower variability. The composite outcome occurred in 47/60 infants. Early oscillatory amplitude variability demonstrated moderate discrimination (AUC 0.72, 95% CI 0.55-0.86), with an AUC of 0.82 (95% CI 0.66-0.95) when combined with oscillatory frequency and weight-normalised DCO2. CONCLUSIONS: Oscillatory amplitude variability during HFOV-VG reflects dynamic ventilator-lung interactions. Its association with adverse respiratory outcome is hypothesis-generating and requires validation in larger independent cohorts.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.