Application of high-frequency ventilation combined with closed-loop automatic oxygen control therapy in neonatal respiratory distress syndrome

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The study population comprised 34 premature infants who had received a diagnosis of NRDS and were under the care of the Neonatal Intensive Care Unit (NICU) at Fujian Children's Hospital during the period spanning from April 2023 to January 2024. To facilitate a rigorous investigation, these participants were systematically stratified into two distinct cohorts, each adhering to specific treatment protocols. Method 17 premature infants who only received high-frequency ventilation as the control group and 17 premature infants who received high-frequency ventilation + closed-loop automatic oxygen control as the study group. The therapeutic effects and complications of the two groups were compared. Results The 2-hour “oxygen saturation of blood” and 4-hour “oxygen saturation of blood” in the control group were lower than those in the experimental group ( P < 0.05 ). The "PO2" of the control group after 1 day of treatment was higher than that of the experimental group ( P < 0.05 ).There was no statistically significant difference in the occurrence of VAP, pulmonary air leakage, pulmonary hemorrhage, grade III-IV intracranial hemorrhage, ROP, and BPD between the two groups ( P > 0.05 ). It is noteworthy that the number of hypoxic interventions in the control group was significantly higher than that in the experimental group, with a p-value less than 0.05. Conclusion The use of high-frequency ventilation + closed-loop automatic oxygen control in Premature infants with NRDS has a positive effect on reducing the occurrence of hypoxemia during treatment, which can significantly reduce the number of interventions when hypoxemia occurs. However, there is no significant difference in the occurrence of common long-term complications such as bronchopulmonary dysplasia in premature infants. Neonatal Respiratory distress syndrome Closed loop automatic oxygen control High frequency ventilation premature infant Introduction Neonatal Respiratory distress syndrome (NRDS) is a common serious disease in neonatal clinical treatment. It is a clinical syndrome in which respiratory distress occurs soon after birth and progressively worsens due to a lack of pulmonary surfactant (PS). Because of its pathological changes in the hyaline membrane of the lungs, it is also called hyaline membrane disease (HMD)[1].It is more common in premature infants. The younger the gestational age, the higher the incidence. At present, continuous positive airway pressure ventilation, pulmonary surfactant, tracheal intubation, etc. are mainly used in clinical treatment for children with NRDS, but the overall efficacy and safety need to be further improved. high frequency oscillatory ventilation ventilation, HFOV can improve oxygenation at a very small tidal volume and reduce lung damage. Newborns with respiratory distress overwhelmingly require oxygen, but this can lead to complications such as retinopathy of prematurity[2]. Therefore, the level of supplemental oxygen needs to be adjusted to maintain blood oxygen saturation (SpO2) within a predetermined range to minimize such complications. However, in routine practice, compliance with SpO2 target ranges varies. Treatment accuracy should be improved through the use of closed-loop automatic oxygen control systems. Such systems monitor SpO2 values in real time and then make adjustments to the inhaled oxygen concentration. Closed-loop automatic oxygen control is associated with an increased percentage of time spent within the target oxygen saturation range and requires fewer manual adjustments to inspired oxygen concentration than manual oxygen control . Closed-loop automatic oxygen control reduces the number and duration of severe desaturation episodes and improves oxygenation[3] . This study mainly explores the efficacy of HFOV and Closed -loop oxygen combined in children with severe NRDS. The report is as follows. Materials and Methods 1.1 General information Thirty four premature infants with NRDS admitted to the NICU ward of Fujian Children 's Hospital from April 2023 to January 2024 were selected and divided into groups according to treatment methods. Seventeen premature infants who only received high-frequency ventilation therapy served as the control group, including 9 males and 4 females; 7 to 15 hours after birth, with an average of gestational age(30.62 ± 2.31); an average of birth weight (1521.12 ± 462.02) g. 17 children were treated with high-frequency ventilation + closed-loop automatic oxygen control as a research group, including 10 males and 7 females; 7 to 16 hours after birth, with an average of gestational age(30.51 ± 2.37); an average of birth weight (1498.24 ± 325.93) g. Inclusion criteria: ① Meet the clinical diagnostic criteria for moderate to severe RDS in "Practical Neonatology", and combined with clinical symptoms and arterial blood gas analysis results, it is clear that the child has respiratory failure, and the effect is not satisfactory after treatment with bronchodilators and other drugs; ② Gestational age 28 ~ 36 weeks of premature infants; ③ General oxygen therapy is ineffective and requires assisted ventilation; ④ Respiratory distress symptoms show progressive worsening; ⑤ Diagnosis and treatment data are kept intact; ⑥ Family members voluntarily agree to the child's participation in the study and sign an informed consent form. Exclusion criteria: ① The presence of congenital malformations and respiratory failure caused by pneumothorax; ② The presence of bleeding tendencies or bleeding diseases, complex congenital heart disease, severe circulatory failure, anemia, etc.; ③ The presence of contraindications to HFOV treatment. Comparing the general information of the two groups, the difference was not statistically significant (P > 0.05) and was comparable. 1.2 Method Premature infants in both groups were given maintenance of water, electrolyte and acid-base balance, nutritional support, vasoactive drugs, infection prevention, and organ function protection . 1.2.1 HFOV treatment HFOV treatment : The child uses a STEPHAN ventilator and a Mindray monitor, which emits an alarm sound. The medical staff promptly checks and evaluates the child's condition, and appropriately adjusts FiO2 to return SpO2 to the target range. Ventilator parameters: The initial value of MAP is set to 11 ~ 25 cmH2O. Based on the patient's condition and blood gas analysis results, adjust up or down by 1 ~ 2 cmH2O/time. Increase MAP cautiously to prevent pulmonary hyperventilation in children. Lower the MAP value immediately after the condition stabilizes. The initial value of the oscillation pressure amplitude is set to 26 ~ 65 cmH2O, and the upper and lower adjustment amplitude is 3 ~ 5 cmH2O/time. The initial value of oscillation frequency is set to 10 ~ 15 Hz/min. The initial value of the inspiration-to-exhalation ratio is set to 50%. The initial value of FiO2 is set to 85% (53% ~ 100%), and SaO2 needs to be maintained at ≥ 90% during adjustment. Reasonable increases or decreases will be made based on the blood gas analysis results of the child. Blood gas indicators must be maintained within an appropriate range. X-ray chest X-ray examination shows that the diaphragm surface is located between the 8th and 9th posterior ribs. MAP < 12 cmH2O, FiO2 < 0.4; arterial blood carbon dioxide partial pressure (PaCO2) is 35–50 mmHg, pH is 7.25–7.45, PaO2 is 50–80 mmHg; the child's SaO2 does not change significantly after the sputum suction operation, so it can be determined Treatment for HFOV was successful. 1.2.2 HFOV + Closed-loop oxygen treatment The HFOV treatment plan, parameter settings, and treatment effectiveness evaluation criteria remain unchanged, and closed-loop automatic oxygen control is added, which is provided by the integrated OxyGenie software (SLE, Croydon, UK). The software uses proportional, integral, and differential algorithms to calculate and appropriately Adjust FiO2 to react to changes in SpO2. OxyGenie uses a proportional-integral-derivative algorithm. In this system, the error is defined as the distance from the midpoint of the target range, and the change in FiO2 is proportional to the error, integral, and derivative. Data is downloaded directly from the ventilator and includes second-by-second recording of ventilator settings, including paired FiO2 and SpO2 results. Data collected were the number and duration of severe desaturation episodes, with severe desaturation below 85%, whether > 30 seconds or > 60 seconds. Data were analyzed to determine time spent within, above, and below the patient's target SpO2 range. Record the time the child became hyperoxic (above their target SpO2 range) or hypoxemic (below their target SpO2 range), the number of manual adjustments, and the number of automatic adjustments made by OxyGenie. The SpO2 control range is between 90% and 94%. The monitor probe that comes with the ventilator is tied to the instep of the child's lower limb. When the FiO2 control has been adjusted to the maximum value of the FiO2 setting range, if the child's SpO2 Still at a low level ( < = SpO2 lower limit - the smaller of 5% and 85%), for the safety of the child, the FiO2 control value will exceed the set FiO2 range maximum value, but the maximum will not exceed the FiO2 set range maximum value + The lesser of 20% and 60% . 1.3 Observation indicators 1.3.1 Efficacy evaluation The child's cyanosis, irritability and other symptoms disappeared, his body temperature returned to normal, his breathing returned to steady, his reaction was good, his complexion was rosy, and his lung function index levels returned to normal. PaCO2 was 35–45 mmHg, PaO2 was 70–90 mmHg, and SpO2 was 90%. ~95%, it is judged that the treatment is effective ; the patient's clinical symptoms and various physical indicators have returned to normal, shortness of breath and pauses occasionally occur, the reaction is average, the complexion is rosy, and the level of lung function indicators has improved significantly, it is judged that the patient has improved; the clinical symptoms of the child If the symptoms, signs and blood gas analysis indicators are not significantly improved compared with before treatment, or are further aggravated, it is judged as no improvement. At the same time, ventilator treatment and hospitalization time of children were observed. 1.3.2 Assessment of blood gas status and oxygenation function The blood gas status of the children was dynamically observed during treatment, and blood gas analysis and detection were performed before treatment and different time point after treatment. The indicators included blood pH, PaCO2, SaO2, and PaO2, and the PaO2/FiO2 and alveolar-arterial blood oxygen fraction were calculated. Pressure difference and oxygenation index (OI) evaluate the patient's oxygenation function. 1.3.3 Security Assessment The children were observed for complications such as pulmonary air leakage, patent ductus arteriosus (PDA), persistent pulmonary hypertension of the newborn (PPHN), intraventricular hemorrhage, chronic lung disease, and pulmonary hemorrhage. 1.4 Statistical methods Statistical methods SPSS 26.0 statistical software was used for data collection and analysis. If the measurement data conforms to the normal distribution, ‾it is expressed as x ± s, and the two independent samples t test is used between groups. Count data were expressed as frequencies (percentages), and chi-square tests were used for comparisons between groups. P < 0.05 indicates that the difference is statistically significant. Results 1 Comparison of the general conditions and clinical characteristics of the two groups of children After two independent samples t test and chi-square test, it was found that there were no differences between the two groups in terms of gender, IVF, twins, mode of delivery, 1 minute, 5 minutes, 10 minutes, PS use, and whether the primary disease was RDS. Statistical significance ( P > 0.05 ). The birth weight and gestational age of the control group were slightly higher than those of the experimental group ( P < 0.05 ). Refer to Table 1 . Table 1 Comparison of general conditions and clinical characteristics of the two groups of children index Control group ( n = 17 ) Experimental group ( n = 17 ) χ 2 / t value P value birth weight 1521.12 ± 462.02 1498.24 ± 325.93 3.011 0.005 gestational age 30.62 ± 2.31 30.51 ± 2.37 3.867 0.001 Gender, n (%) 0.267 0.082 male 8 (47.0) 10 (58.9) female 9 (53.0) 7 (41.1) In vitro fertilization, n (%) 3(17.6) 1 (5.9) - 0.601 Twins, n (%) 3(17.6) 2 (11.8) - 1.000 Mode of delivery, n (%) < 0.001 1.000 normal delivery 8 (47.1) 8 (47.1) cesarean section 9 (52.9) 9 (52.9) 1 minute 6.65 ± 1.27 6.82 ± 2.24 -0.282 0.780 5 minutes 9.00 ± 0.94 8.65 ± 1.46 0.841 0.406 10 minutes 9.71 ± 0.47 9.41 ± 0.87 1.226 0.232 PS use 5 (29.4) 7 (41.2) 0.515 0.473 Whether the primary disease is RDS, n (%) 1.850 0.604 Level 1 9 (52.9) 6 (35.3) level 2 7 (41.2) 9 (52.9) Level 3 0(0) 1 (5.9) level 4 1 (5.9) 1 (5.9) 2 Comparison of two sets of high-frequency parameters Two independent samples t -test found that there was no statistical significance in the comparison of RR, MAP, amplitude, and FiO2 between the two groups ( P > 0.05 ). Refer to Table 2 . Table 2 Comparison of two groups of high-frequency parameters index Control group ( n = 17 ) Experimental group ( n = 17 ) t value P value RR 10.53 ± 0.72 10.65 ± 0.93 -0.413 0.683 MAP 9.41 ± 2.06 14.35 ± 19.32 -1.049 0.302 amplitude 29.59 ± 5.40 29.65 ± 3.66 -0.037 0.971 FiO2 38.24 ± 11.85 49.76 ± 20.18 -2.031 0.053 3 Comparison of vital signs between the two groups After two independent samples t -test, it was found that the two groups had 2-hour " heart rate, systolic blood pressure, diastolic blood pressure ", 4-hour " heart rate, systolic blood pressure, diastolic blood pressure ", 1-day treatment "PCO2", 2-day treatment "PO2, PCO2", There was no statistically significant difference in "PO2, PCO2" after 3 days of treatment and "PO2, PCO2" after 5 days of treatment ( P > 0.05 ). The 2-hour “oxygen saturation of blood” and 4-hour “oxygen saturation of blood” in the control group were lower than those in the experimental group ( P < 0.05 ). The "PO2" of the control group after 1 day of treatment was higher than that of the experimental group ( P < 0.05 ). Refer to Table 3 . Table 3 Comparison of vital signs between the two groups index Control group ( n = 17 ) Experimental group ( n = 17 ) t value P value 2 hours heart rate 152.29 ± 14.46 152.76 ± 4.91 -0.127 0.900 systolic blood pressure 64.88 ± 5.10 64.88 ± 3.76 < 0.001 1.000 diastolic blood pressure 32.65 ± 4.14 34.47 ± 3.20 -1.437 0.160 blood oxygen 91.53 ± 1.12 92.94 ± 0.90 -4.042 < 0.001 4 hours heart rate 152.06 ± 11.66 158.53 ± 9.01 -1.810 0.080 systolic blood pressure 63.94 ± 5.93 65.71 ± 6.07 -0.857 0.398 diastolic blood pressure 33.18 ± 5.40 34.76 ± 3.15 -1.047 0.303 oxygen saturation of blood 91.41 ± 0.87 93.65 ± 1.11 -6.517 < 0.001 Treatment 1 day PO2 76.53 ± 8.74 67.06 ± 6.09 3.666 0.001 PCO2 47.47 ± 4.85 48.24 ± 4.47 -0.478 0.636 Treatment 2 days PO2 73.35 ± 12.51 66.41 ± 11.23 1.702 0.098 PCO2 48.47 ± 3.28 47.94 ± 3.75 0.438 0.664 Treatment for 3 days PO2 73.06 ± 7.42 72.41 ± 7.42 0.254 0.801 PCO2 45.88 ± 2.98 46.18 ± 3.30 -0.273 0.787 Treatment for 5 days PO2 75.29 ± 10.28 75.41 ± 9.91 -0.034 0.973 PCO2 42.06 ± 4.10 42.59 ± 4.36 -0.365 0.718 4 Comparison of complications between the two groups The chi-square test found that there was no statistically significant difference in the occurrence of VAP, pulmonary air leakage, pulmonary hemorrhage, grade III-IV intracranial hemorrhage, ROP, and BPD between the two groups ( P > 0.05 ). Refer to Table 4 . Table 4 Comparison of complications between the two groups index Control group ( n = 17 ) Experimental group ( n = 17 ) χ2 value _ P value VAP, n (%) 7 (41.2) 7 (41.2) < 0.001 1.000 Pulmonary air leak, n (%) 6 (35.3) 6 (35.3) < 0.001 1.000 Pulmonary hemorrhage, n (%) 5 (29.4) 7 (41.2) 0.515 0.473 Grade III-IV intracranial hemorrhage, n (%) 5 (29.4) 6 (35.3) 0.134 0.714 ROP, n (%) 8 (47.1) 6 (35.3) 0.486 0.486 BPD, n (%) 7 (41.2) 7 (41.2) < 0.001 1.000 5 Comparison of intervention status between the two groups The results of the independent samples t-test indicate that there was no statistically significant difference in the number of hyperoxic intervention times and intervention time between the two groups, as evidenced by a p-value greater than 0.05. However, it is noteworthy that the number of hypoxic interventions in the control group was significantly higher than that in the experimental group, with a p-value less than 0.05. These findings are presented in Table 5 . Table 5 Comparison of intervention status between the two groups index Control group ( n = 17 ) Experimental group ( n = 17 ) t value P value Number of hypoxic interventions 5.76 ± 1.95 4.47 ± 1.70 2.060 0.048 Number of hyperoxic interventions 5.59 ± 1.58 5.76 ± 1.64 -0.319 0.752 Intervention time consuming 55.88 ± 76.69 25.71 ± 7.94 1.614 0.116 Discussion Children with NRDS often develop clinical manifestations soon after birth, and respiratory distress usually occurs within 6 hours after birth. Extremely immature premature infants at 26 to 30 weeks of gestation can develop symptoms in the delivery room; while some more mature premature infants (> 34 weeks) may develop typical NRDS symptoms 3 to 4 hours after birth, or even later, this may be due to the fact that there is a small amount of surfactant stored in the early stage, but insufficient production occurs after it is consumed. RDS is usually the most severe 24 to 48 hours after birth, with a high mortality rate[ 4 ]. Those who survive for > 3 days have increased lung maturity and gradually recover, manifested by increased urine output, relief of dyspnea, and improvement in partial pressure of blood oxygen. wait. The incidence of NRDS increases with decreasing gestational age in preterm infants. The incidence rate is 30–60% in premature infants aged 28 to 32 weeks, 15–30% in those aged 32 to 36 weeks, and 5% in those aged > 37 weeks[ 5 ]. It rarely occurs in term infants. High-risk factors include: perinatal asphyxia, hypothermia, placenta previa, placental abruption, maternal hypotension, etc. Improper ventilation and oxygen concentration may lead to complications such as atelectasis and reduced cardiac output. Children treated with HFOV for a long time may cause oxygen toxicity. Therefore, it is of great clinical significance to strengthen in-depth research on effective treatment methods for term infants with NRDS[ 6 ]. Hyperoxemia in premature infants with lung disease is almost always caused by excess FiO2, whereas episodes of hypoxemia are mostly spontaneous and often associated with increased activity and lung disease in the infant. The severity and duration of these events are largely influenced by the response of medical personnel. Hyperoxemia often occurs in premature infants. This is because when trying to avoid episodes of hypoxemia, the FiO2 is often set above the level needed to keep SpO2 within the target range. In other cases, the increase in FiO2 caused by hypoxemia does not return to baseline levels immediately after symptom resolution, resulting in hyperoxemia. Oxygenation fluctuations increase with postnatal age and are common in infants with RDS. This study mainly explores the effect and safety of high-frequency oscillatory ventilation + closed-loop automatic oxygen control in children with NRDS[ 10 ], and compares the difference in the condition of children with NRDS between HFOV + closed-loop automatic oxygen control therapy and manual oxygen saturation control alone. Understand the impact of increasing the target SpO2 time of newborns on disease development and prognosis, aiming to further clarify effective and safe treatment options for children with NRDS. The closed-loop automatic oxygen control system uses real-time monitored SpO2 values to calculate and adjust FiO2 without any human intervention. Monitor the resulting changes in SpO2 and make further changes to FiO2 as needed. Therefore, closed-loop automated oxygen control systems may provide a solution for low compliance with target blood oxygen saturation levels, reduce the need for manual adjustments (thereby reducing workload), and reduce complications. The closed-loop automatic oxygen control system continuously monitors blood oxygen saturation and feeds the data into an algorithm that determines and makes appropriate adjustments to blood oxygen saturation. Monitor the results of this adjustment and make further changes if needed. The relationship between FiO2 and SpO2 in neonates requiring respiratory support and supplemental oxygen is nonlinear and complex. Therefore, the algorithm used reflects this. Several types of algorithms have been used. Sixteen single or multicenter clinical studies have been conducted comparing closed-loop automated oxygen control with manual oxygen control in neonates to determine whether automated FiO2 control is associated with greater achievement of SpO2 goals[ 7 ]. They consistently demonstrated that closed-loop automatic oxygen control kept patients in their target SpO2 range for a significantly higher proportion of time than manual control. Closed-loop automatic oxygen control has been shown to reduce hyperoxic episodes. Oxygenation stability is also affected by the SpO2 target range. An observational study conducted after a relatively small change in the oxygen saturation target range from 90–95% to 88–94% showed that SpO2 was maintained in the new and old target ranges for a similar proportion of time, but at a lower target range Within the period, the proportion of time with SpO2 < 80% increased from 1.9–4.0%[ 8 ]. This was also observed in a group of infants enrolled in the support trial[ 9 ], in which the incidence of hypoxemia increased with postnatal age, 85 to 89% compared with the target range of 91 to 95% infants have a higher incidence of hypoxemia. This study also has some limitations. Firstly, due to the recent development of closed-loop automatic oxygen control in our region, there are not many cases available for control. Despite our efforts to include all eligible patients, the number of cases is still not sufficient, which may be a factor affecting the accuracy of the conclusion. However, we still believe that our study has certain clinical significance. In addition, there are relatively few indicators evaluated at specific times, and the selection of monitoring indicators at specific time points can be further subdivided. I believe that further research in the future can make up for these shortcomings. Finally, this is a retrospective study with lower statistical validity compared to prospective clinical studies. Conclusion The use of high-frequency ventilation + closed-loop automatic oxygen control in Premature infants with NRDS has a positive effect on reducing the occurrence of hypoxemia during treatment, which can significantly reduce the number of interventions when hypoxemia occurs. However, there is no significant difference in the occurrence of common long-term complications such as bronchopulmonary dysplasia in premature infants. In addition, during the treatment period, the treatment indications must be strictly grasped to avoid oxygen poisoning caused by hyperoxia. According to the actual changes in the patient's condition, the best ventilation method should be selected for treatment in a timely manner to maximize the efficacy and safety. Declarations Ethics approval and consent to participate This study was approved by the ethics committee of Fujian Children’s Hospital and followed the guidelines outlined in the Declaration of Helsinki. Written informed consent was obtained from all the patient’s parents. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding No. Author Contribution Shan-Biao Huang designed the study, performed the statistical analysis, participated in the operation, and drafted the manuscript. Jia-Jia Lin, Hong Lin and Zi-Zhou Fu helped to collect the clinical data. Yun-Feng Lin supervised the study. All authors read and approved the fnal manuscript. Acknowledgements We highly acknowledge the following researchers’ contributions: Hui-Zi Lin, Qiong-Xia Ou, Biao Liu, Shao-Ru Huang, and Qian Cheng. And we hope every preterm infant with NRDS will have a better prognosis. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author at the reasonable request. References Cawood S, Rae B, Naidoo K. High-frequency oscillatory ventilation in a tertiary paediatric intensive care unit. Southern African Journal of Critical Care. Link to paper; 2019. Chattopadhyay A, Gupta S, Sankar J, Kabra S, Lodha R. Outcomes of severe PARDS on high-frequency oscillatory ventilation – A single centre experience. Indian J Pediatr. 2020;87:185–91. Link to paper. Chen Z, Chen J. Alternate application efficacy of high-frequency oscillatory ventilation and constant-frequency mechanical ventilation. Chin J Prim Med Pharm. 2020;27:541–5. Link to paper. De Jager P, Burgerhof J, Koopman AA, Markhorst D, Kneyber M. Lung volume optimization maneuver responses in pediatric high-frequency oscillatory ventilation. Am J Respir Crit Care Med. 2019;199(9):1034–6. Link to paper. Gabr R, Aboo M, Zahraa J. High frequency oscillatory ventilation in pediatric practice. International Journal of Pediatrics & Neonatal Care. Link to paper; 2021. Liu K, Chen L, Xiong J, Xie S, Hu Y, Shi Y. HFOV vs CMV for neonates with moderate-to-severe perinatal onset acute respiratory distress syndrome (NARDS). Eur J Pediatrics. 2021;180:2155–64. Link to paper. Solís-García G, González-Pacheco N, Ramos-Navarro C, Rodríguez Sánchez de la Blanca, A., Sánchez-Luna M. (2021). Target volume-guarantee in high‐frequency oscillatory ventilation for preterm respiratory distress syndrome. Pediatric Pulmonology, 56, 2597–2603. Link to paper. Wang T, Zhu Y, Wu L-Y. Clinical study of high frequency oscillatory ventilation on neonatal respiratory distress syndrome. Education and Human Science: DEStech Transactions on Social Science; 2018. Link to paper. Wang T, Zhu Y, Yin J, Zhao L-Y, Wang H-J, Xiao C-W, Wu L-Y. (2022). The effect of high-frequency oscillatory ventilator combined with pulmonary surfactant. Medicine, 101. Link to paper. Zheng Y, Chen Y-K, Lin S, Cao H, Chen Q. High-frequency oscillatory ventilation, combined with prone positioning, in infants with acute respiratory distress syndrome. J Cardiothorac Vasc Anesth. 2022;36:3847–54. Link to paper. Additional Declarations No competing interests reported. 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It is a clinical syndrome in which respiratory distress occurs soon after birth and progressively worsens due to a lack of pulmonary surfactant (PS). Because of its pathological changes in the hyaline membrane of the lungs, it is also called hyaline membrane disease (HMD)[1].It is more common in premature infants. The younger the gestational age, the higher the incidence. At present, continuous positive airway pressure ventilation, pulmonary surfactant, tracheal intubation, etc. are mainly used in clinical treatment for children with NRDS, but the overall efficacy and safety need to be further improved. high frequency oscillatory ventilation ventilation, HFOV can improve oxygenation at a very small tidal volume and reduce lung damage. Newborns with respiratory distress overwhelmingly require oxygen, but this can lead to complications such as retinopathy of prematurity[2]. Therefore, the level of supplemental oxygen needs to be adjusted to maintain blood oxygen saturation (SpO2) within a predetermined range to minimize such complications. However, in routine practice, compliance with SpO2 target ranges varies. Treatment accuracy should be improved through the use of closed-loop automatic oxygen control systems. Such systems monitor SpO2 values in real time and then make adjustments to the inhaled oxygen concentration. Closed-loop automatic oxygen control is associated with an increased percentage of time spent within the target oxygen saturation range and requires fewer manual adjustments to inspired oxygen concentration than manual oxygen control . Closed-loop automatic oxygen control reduces the number and duration of severe desaturation episodes and improves oxygenation[3] . This study mainly explores the efficacy of HFOV and Closed -loop oxygen combined in children with severe NRDS. The report is as follows.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003ch3\u003e1.1 General information\u003ch3\u003e\u003cp\u003eThirty four premature infants with NRDS admitted to the NICU ward of Fujian Children 's Hospital from April 2023 to January 2024 were selected and divided into groups according to treatment methods. Seventeen premature infants who only received high-frequency ventilation therapy served as the control group, including 9 males and 4 females; 7 to 15 hours after birth, with an average of gestational age(30.62 ± 2.31); an average of birth weight (1521.12 ± 462.02) g. 17 children were treated with high-frequency ventilation + closed-loop automatic oxygen control as a research group, including 10 males and 7 females; 7 to 16 hours after birth, with an average of gestational age(30.51 ± 2.37); an average of birth weight (1498.24 ± 325.93) g.\u003c/p\u003e \u003cp\u003eInclusion criteria: ① Meet the clinical diagnostic criteria for moderate to severe RDS in \"Practical Neonatology\", and combined with clinical symptoms and arterial blood gas analysis results, it is clear that the child has respiratory failure, and the effect is not satisfactory after treatment with bronchodilators and other drugs; ② Gestational age 28 ~ 36 weeks of premature infants; ③ General oxygen therapy is ineffective and requires assisted ventilation; ④ Respiratory distress symptoms show progressive worsening; ⑤ Diagnosis and treatment data are kept intact; ⑥ Family members voluntarily agree to the child's participation in the study and sign an informed consent form. Exclusion criteria: ① The presence of congenital malformations and respiratory failure caused by pneumothorax; ② The presence of bleeding tendencies or bleeding diseases, complex congenital heart disease, severe circulatory failure, anemia, etc.; ③ The presence of contraindications to HFOV treatment. Comparing the general information of the two groups, the difference was not statistically significant (P \u0026gt; 0.05) and was comparable.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003cdiv id=\"Sec3\" class=\"Section3\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e\u003c/h2\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Method\u003c/h3\u003e\n\u003cp\u003ePremature infants in both groups were given maintenance of water, electrolyte and acid-base balance, nutritional support, vasoactive drugs, infection prevention, and organ function protection .\u003c/p\u003e\u003ch2\u003e1.2.1 HFOV treatment\u003c/h2\u003e\u003cp\u003eHFOV treatment : The child uses a STEPHAN ventilator and a Mindray monitor, which emits an alarm sound. The medical staff promptly checks and evaluates the child's condition, and appropriately adjusts FiO2 to return SpO2 to the target range. Ventilator parameters: The initial value of MAP is set to 11 ~ 25 cmH2O. Based on the patient's condition and blood gas analysis results, adjust up or down by 1 ~ 2 cmH2O/time. Increase MAP cautiously to prevent pulmonary hyperventilation in children. Lower the MAP value immediately after the condition stabilizes. The initial value of the oscillation pressure amplitude is set to 26 ~ 65 cmH2O, and the upper and lower adjustment amplitude is 3 ~ 5 cmH2O/time. The initial value of oscillation frequency is set to 10 ~ 15 Hz/min. The initial value of the inspiration-to-exhalation ratio is set to 50%. The initial value of FiO2 is set to 85% (53% ~ 100%), and SaO2 needs to be maintained at ≥ 90% during adjustment. Reasonable increases or decreases will be made based on the blood gas analysis results of the child. Blood gas indicators must be maintained within an appropriate range. X-ray chest X-ray examination shows that the diaphragm surface is located between the 8th and 9th posterior ribs. MAP \u0026lt; 12 cmH2O, FiO2 \u0026lt; 0.4; arterial blood carbon dioxide partial pressure (PaCO2) is 35–50 mmHg, pH is 7.25–7.45, PaO2 is 50–80 mmHg; the child's SaO2 does not change significantly after the sputum suction operation, so it can be determined Treatment for HFOV was successful.\u003c/p\u003e\u003ch2\u003e1.2.2 HFOV + Closed-loop oxygen treatment\u003c/h2\u003e\u003cp\u003eThe HFOV treatment plan, parameter settings, and treatment effectiveness evaluation criteria remain unchanged, and closed-loop automatic oxygen control is added, which is provided by the integrated OxyGenie software (SLE, Croydon, UK). The software uses proportional, integral, and differential algorithms to calculate and appropriately Adjust FiO2 to react to changes in SpO2. OxyGenie uses a proportional-integral-derivative algorithm. In this system, the error is defined as the distance from the midpoint of the target range, and the change in FiO2 is proportional to the error, integral, and derivative. Data is downloaded directly from the ventilator and includes second-by-second recording of ventilator settings, including paired FiO2 and SpO2 results. Data collected were the number and duration of severe desaturation episodes, with severe desaturation below 85%, whether \u0026gt; 30 seconds or \u0026gt; 60 seconds. Data were analyzed to determine time spent within, above, and below the patient's target SpO2 range. Record the time the child became hyperoxic (above their target SpO2 range) or hypoxemic (below their target SpO2 range), the number of manual adjustments, and the number of automatic adjustments made by OxyGenie. The SpO2 control range is between 90% and 94%. The monitor probe that comes with the ventilator is tied to the instep of the child's lower limb. When the FiO2 control has been adjusted to the maximum value of the FiO2 setting range, if the child's SpO2 Still at a low level ( \u0026lt; = SpO2 lower limit - the smaller of 5% and 85%), for the safety of the child, the FiO2 control value will exceed the set FiO2 range maximum value, but the maximum will not exceed the FiO2 set range maximum value + The lesser of 20% and 60% .\u003c/p\u003e\u003ch2\u003e1.3 Observation indicators\u003c/h2\u003e\u003cb\u003e1.3.1 Efficacy evaluation\u003c/b\u003e\u003cp\u003eThe child's cyanosis, irritability and other symptoms disappeared, his body temperature returned to normal, his breathing returned to steady, his reaction was good, his complexion was rosy, and his lung function index levels returned to normal. PaCO2 was 35–45 mmHg, PaO2 was 70–90 mmHg, and SpO2 was 90%. ~95%, it is judged that the treatment is effective ; the patient's clinical symptoms and various physical indicators have returned to normal, shortness of breath and pauses occasionally occur, the reaction is average, the complexion is rosy, and the level of lung function indicators has improved significantly, it is judged that the patient has improved; the clinical symptoms of the child If the symptoms, signs and blood gas analysis indicators are not significantly improved compared with before treatment, or are further aggravated, it is judged as no improvement. At the same time, ventilator treatment and hospitalization time of children were observed.\u003c/p\u003e\u003ch2\u003e1.3.2 Assessment of blood gas status and oxygenation function\u003c/h2\u003e\u003cp\u003eThe blood gas status of the children was dynamically observed during treatment, and blood gas analysis and detection were performed before treatment and different time point after treatment. The indicators included blood pH, PaCO2, SaO2, and PaO2, and the PaO2/FiO2 and alveolar-arterial blood oxygen fraction were calculated. Pressure difference and oxygenation index (OI) evaluate the patient's oxygenation function.\u003c/p\u003e\u003ch2\u003e1.3.3 Security Assessment\u003c/h2\u003e\u003cp\u003eThe children were observed for complications such as pulmonary air leakage, patent ductus arteriosus (PDA), persistent pulmonary hypertension of the newborn (PPHN), intraventricular hemorrhage, chronic lung disease, and pulmonary hemorrhage.\u003c/p\u003e\u003ch2\u003e1.4 Statistical methods\u003c/h2\u003e\u003cp\u003e \u003cstrong\u003eStatistical methods\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eSPSS 26.0 statistical software was used for data collection and analysis. If the measurement data conforms to the normal distribution, ‾it is expressed as \u003cem\u003ex\u003c/em\u003e ± s, and the two independent samples \u003cem\u003et\u003c/em\u003e test is used between groups. Count data were expressed as frequencies (percentages), and chi-square tests were used for comparisons between groups. \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 indicates that the difference is statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003e1 Comparison of the general conditions and clinical characteristics of the two groups of children\u003c/h2\u003e\u003cp\u003eAfter two independent samples \u003cem\u003et\u003c/em\u003e test and chi-square test, it was found that there were no differences between the two groups in terms of gender, IVF, twins, mode of delivery, 1 minute, 5 minutes, 10 minutes, PS use, and whether the primary disease was RDS. Statistical significance ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 ). The birth weight and gestational age of the control group were slightly higher than those of the experimental group ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ). Refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of general conditions and clinical characteristics of the two groups of children\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eindex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group ( \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental group ( \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e \u003csup\u003e2\u003c/sup\u003e / \u003cem\u003et\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ebirth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1521.12\u0026thinsp;\u0026plusmn;\u0026thinsp;462.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1498.24\u0026thinsp;\u0026plusmn;\u0026thinsp;325.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egestational age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (47.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (58.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn vitro fertilization, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwins, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode of delivery, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 minute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePS use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether the primary disease is RDS, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elevel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elevel 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e2 Comparison of two sets of high-frequency parameters\u003c/h3\u003e\n\u003cp\u003eTwo independent samples \u003cem\u003et\u003c/em\u003e-test found that there was no statistical significance in the comparison of RR, MAP, amplitude, and FiO2 between the two groups ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 ). Refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of two groups of high-frequency parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eindex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group ( \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental group ( \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.35\u0026thinsp;\u0026plusmn;\u0026thinsp;19.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eamplitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29.59\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e29.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFiO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e38.24\u0026thinsp;\u0026plusmn;\u0026thinsp;11.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e49.76\u0026thinsp;\u0026plusmn;\u0026thinsp;20.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e3 Comparison of vital signs between the two groups\u003c/h3\u003e\n\u003cp\u003eAfter two independent samples \u003cem\u003et\u003c/em\u003e -test, it was found that the two groups had 2-hour \" heart rate, systolic blood pressure, diastolic blood pressure \", 4-hour \" heart rate, systolic blood pressure, diastolic blood pressure \", 1-day treatment \"PCO2\", 2-day treatment \"PO2, PCO2\", There was no statistically significant difference in \"PO2, PCO2\" after 3 days of treatment and \"PO2, PCO2\" after 5 days of treatment ( P\u0026thinsp;\u0026gt;\u0026thinsp;0.05 ). The 2-hour \u0026ldquo;oxygen saturation of blood\u0026rdquo; and 4-hour \u0026ldquo;oxygen saturation of blood\u0026rdquo; in the control group were lower than those in the experimental group ( P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ). The \"PO2\" of the control group after 1 day of treatment was higher than that of the experimental group ( P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ). Refer to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of vital signs between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eindex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group ( \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental group ( \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eheart rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e152.29\u0026thinsp;\u0026plusmn;\u0026thinsp;14.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e152.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esystolic blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e64.88\u0026thinsp;\u0026plusmn;\u0026thinsp;5.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e64.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediastolic blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e32.65\u0026thinsp;\u0026plusmn;\u0026thinsp;4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eblood oxygen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e91.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e92.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-4.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eheart rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e152.06\u0026thinsp;\u0026plusmn;\u0026thinsp;11.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e158.53\u0026thinsp;\u0026plusmn;\u0026thinsp;9.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esystolic blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e63.94\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e65.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediastolic blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e33.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoxygen saturation of blood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e91.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e93.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-6.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment 1 day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e76.53\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e67.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e47.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e48.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment 2 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e73.35\u0026thinsp;\u0026plusmn;\u0026thinsp;12.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e66.41\u0026thinsp;\u0026plusmn;\u0026thinsp;11.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e48.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e47.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment for 3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e73.06\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e72.41\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment for 5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e75.29\u0026thinsp;\u0026plusmn;\u0026thinsp;10.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.41\u0026thinsp;\u0026plusmn;\u0026thinsp;9.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e42.59\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e4 Comparison of complications between the two groups\u003c/h3\u003e\n\u003cp\u003eThe chi-square test found that there was no statistically significant difference in the occurrence of VAP, pulmonary air leakage, pulmonary hemorrhage, grade III-IV intracranial hemorrhage, ROP, and BPD between the two groups ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 ). Refer to Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of complications between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eindex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group ( \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental group ( \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ2\u003c/em\u003e value \u003csup\u003e_\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAP, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary air leak, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary hemorrhage, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade III-IV intracranial hemorrhage, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eROP, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBPD, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e5 Comparison of intervention status between the two groups\u003c/h3\u003e\n\u003cp\u003eThe results of the independent samples t-test indicate that there was no statistically significant difference in the number of hyperoxic intervention times and intervention time between the two groups, as evidenced by a p-value greater than 0.05. However, it is noteworthy that the number of hypoxic interventions in the control group was significantly higher than that in the experimental group, with a p-value less than 0.05. These findings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"±\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"±\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of intervention status between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eindex\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group ( \u003cem\u003en\u003c/em\u003e = 17 )\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental group ( \u003cem\u003en\u003c/em\u003e = 17 )\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of hypoxic interventions\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e5.76 ± 1.95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e4.47 ± 1.70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.060\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of hyperoxic interventions\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e5.59 ± 1.58\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e5.76 ± 1.64\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.319\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention time consuming\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e55.88 ± 76.69\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e \u003cp\u003e25.71 ± 7.94\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.614\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eChildren with NRDS often develop clinical manifestations soon after birth, and respiratory distress usually occurs within 6 hours after birth. Extremely immature premature infants at 26 to 30 weeks of gestation can develop symptoms in the delivery room; while some more mature premature infants (\u0026gt; 34 weeks) may develop typical NRDS symptoms 3 to 4 hours after birth, or even later, this may be due to the fact that there is a small amount of surfactant stored in the early stage, but insufficient production occurs after it is consumed. RDS is usually the most severe 24 to 48 hours after birth, with a high mortality rate[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Those who survive for \u0026gt; 3 days have increased lung maturity and gradually recover, manifested by increased urine output, relief of dyspnea, and improvement in partial pressure of blood oxygen. wait. The incidence of NRDS increases with decreasing gestational age in preterm infants. The incidence rate is 30–60% in premature infants aged 28 to 32 weeks, 15–30% in those aged 32 to 36 weeks, and 5% in those aged \u0026gt; 37 weeks[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It rarely occurs in term infants. High-risk factors include: perinatal asphyxia, hypothermia, placenta previa, placental abruption, maternal hypotension, etc. Improper ventilation and oxygen concentration may lead to complications such as atelectasis and reduced cardiac output. Children treated with HFOV for a long time may cause oxygen toxicity. Therefore, it is of great clinical significance to strengthen in-depth research on effective treatment methods for term infants with NRDS[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Hyperoxemia in premature infants with lung disease is almost always caused by excess FiO2, whereas episodes of hypoxemia are mostly spontaneous and often associated with increased activity and lung disease in the infant. The severity and duration of these events are largely influenced by the response of medical personnel. Hyperoxemia often occurs in premature infants. This is because when trying to avoid episodes of hypoxemia, the FiO2 is often set above the level needed to keep SpO2 within the target range. In other cases, the increase in FiO2 caused by hypoxemia does not return to baseline levels immediately after symptom resolution, resulting in hyperoxemia. Oxygenation fluctuations increase with postnatal age and are common in infants with RDS. This study mainly explores the effect and safety of high-frequency oscillatory ventilation + closed-loop automatic oxygen control in children with NRDS[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and compares the difference in the condition of children with NRDS between HFOV + closed-loop automatic oxygen control therapy and manual oxygen saturation control alone. Understand the impact of increasing the target SpO2 time of newborns on disease development and prognosis, aiming to further clarify effective and safe treatment options for children with NRDS.\u003c/p\u003e\u003cp\u003eThe closed-loop automatic oxygen control system uses real-time monitored SpO2 values to calculate and adjust FiO2 without any human intervention. Monitor the resulting changes in SpO2 and make further changes to FiO2 as needed. Therefore, closed-loop automated oxygen control systems may provide a solution for low compliance with target blood oxygen saturation levels, reduce the need for manual adjustments (thereby reducing workload), and reduce complications. The closed-loop automatic oxygen control system continuously monitors blood oxygen saturation and feeds the data into an algorithm that determines and makes appropriate adjustments to blood oxygen saturation. Monitor the results of this adjustment and make further changes if needed. The relationship between FiO2 and SpO2 in neonates requiring respiratory support and supplemental oxygen is nonlinear and complex. Therefore, the algorithm used reflects this. Several types of algorithms have been used.\u003c/p\u003e\u003cp\u003eSixteen single or multicenter clinical studies have been conducted comparing closed-loop automated oxygen control with manual oxygen control in neonates to determine whether automated FiO2 control is associated with greater achievement of SpO2 goals[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. They consistently demonstrated that closed-loop automatic oxygen control kept patients in their target SpO2 range for a significantly higher proportion of time than manual control. Closed-loop automatic oxygen control has been shown to reduce hyperoxic episodes. Oxygenation stability is also affected by the SpO2 target range. An observational study conducted after a relatively small change in the oxygen saturation target range from 90–95% to 88–94% showed that SpO2 was maintained in the new and old target ranges for a similar proportion of time, but at a lower target range Within the period, the proportion of time with SpO2 \u0026lt; 80% increased from 1.9–4.0%[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This was also observed in a group of infants enrolled in the support trial[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], in which the incidence of hypoxemia increased with postnatal age, 85 to 89% compared with the target range of 91 to 95% infants have a higher incidence of hypoxemia.\u003c/p\u003e\u003cp\u003eThis study also has some limitations. Firstly, due to the recent development of closed-loop automatic oxygen control in our region, there are not many cases available for control. Despite our efforts to include all eligible patients, the number of cases is still not sufficient, which may be a factor affecting the accuracy of the conclusion. However, we still believe that our study has certain clinical significance. In addition, there are relatively few indicators evaluated at specific times, and the selection of monitoring indicators at specific time points can be further subdivided. I believe that further research in the future can make up for these shortcomings. Finally, this is a retrospective study with lower statistical validity compared to prospective clinical studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe use of high-frequency ventilation + closed-loop automatic oxygen control in Premature infants with NRDS has a positive effect on reducing the occurrence of hypoxemia during treatment, which can significantly reduce the number of interventions when hypoxemia occurs. However, there is no significant difference in the occurrence of common long-term complications such as bronchopulmonary dysplasia in premature infants. In addition, during the treatment period, the treatment indications must be strictly grasped to avoid oxygen poisoning caused by hyperoxia. According to the actual changes in the patient's condition, the best ventilation method should be selected for treatment in a timely manner to maximize the efficacy and safety.\u003c/p\u003e"},{"header":"Declarations","content":" \u003ch2\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the ethics committee of Fujian Children\u0026rsquo;s Hospital and followed the guidelines outlined in the Declaration of Helsinki. Written informed consent was obtained from all the patient\u0026rsquo;s parents.\u003c/p\u003e \u003ch2\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eShan-Biao Huang designed the study, performed the statistical analysis, participated in the operation, and drafted the manuscript. Jia-Jia Lin, Hong Lin and Zi-Zhou Fu helped to collect the clinical data. Yun-Feng Lin supervised the study. All authors read and approved the fnal manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe highly acknowledge the following researchers\u0026rsquo; contributions: Hui-Zi Lin, Qiong-Xia Ou, Biao Liu, Shao-Ru Huang, and Qian Cheng. And we hope every preterm infant with NRDS will have a better prognosis.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author at the reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCawood S, Rae B, Naidoo K. High-frequency oscillatory ventilation in a tertiary paediatric intensive care unit. Southern African Journal of Critical Care. Link to paper; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChattopadhyay A, Gupta S, Sankar J, Kabra S, Lodha R. Outcomes of severe PARDS on high-frequency oscillatory ventilation \u0026ndash; A single centre experience. Indian J Pediatr. 2020;87:185\u0026ndash;91. Link to paper.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Z, Chen J. Alternate application efficacy of high-frequency oscillatory ventilation and constant-frequency mechanical ventilation. Chin J Prim Med Pharm. 2020;27:541\u0026ndash;5. Link to paper.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Jager P, Burgerhof J, Koopman AA, Markhorst D, Kneyber M. Lung volume optimization maneuver responses in pediatric high-frequency oscillatory ventilation. Am J Respir Crit Care Med. 2019;199(9):1034\u0026ndash;6. Link to paper.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGabr R, Aboo M, Zahraa J. High frequency oscillatory ventilation in pediatric practice. International Journal of Pediatrics \u0026amp; Neonatal Care. Link to paper; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu K, Chen L, Xiong J, Xie S, Hu Y, Shi Y. HFOV vs CMV for neonates with moderate-to-severe perinatal onset acute respiratory distress syndrome (NARDS). Eur J Pediatrics. 2021;180:2155\u0026ndash;64. Link to paper.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSol\u0026iacute;s-Garc\u0026iacute;a G, Gonz\u0026aacute;lez-Pacheco N, Ramos-Navarro C, Rodr\u0026iacute;guez S\u0026aacute;nchez de la Blanca, A., S\u0026aacute;nchez-Luna M. (2021). Target volume-guarantee in high‐frequency oscillatory ventilation for preterm respiratory distress syndrome. Pediatric Pulmonology, 56, 2597\u0026ndash;2603. Link to paper.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang T, Zhu Y, Wu L-Y. Clinical study of high frequency oscillatory ventilation on neonatal respiratory distress syndrome. Education and Human Science: DEStech Transactions on Social Science; 2018. Link to paper.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang T, Zhu Y, Yin J, Zhao L-Y, Wang H-J, Xiao C-W, Wu L-Y. (2022). The effect of high-frequency oscillatory ventilator combined with pulmonary surfactant. Medicine, 101. Link to paper.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng Y, Chen Y-K, Lin S, Cao H, Chen Q. High-frequency oscillatory ventilation, combined with prone positioning, in infants with acute respiratory distress syndrome. J Cardiothorac Vasc Anesth. 2022;36:3847\u0026ndash;54. Link to paper.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neonatal Respiratory distress syndrome, Closed loop automatic oxygen control, High frequency ventilation, premature infant","lastPublishedDoi":"10.21203/rs.3.rs-4869171/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4869171/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn the realm of retrospective research, the researcher embarked on a comprehensive inquiry with the primary aim of assessing the effectiveness and safety of high-frequency oscillatory ventilation (HFOV) in conjunction with closed-loop oxygen control for the management of severe neonatal respiratory distress syndrome (NRDS) in the pediatric population. The study population comprised 34 premature infants who had received a diagnosis of NRDS and were under the care of the Neonatal Intensive Care Unit (NICU) at Fujian Children's Hospital during the period spanning from April 2023 to January 2024. To facilitate a rigorous investigation, these participants were systematically stratified into two distinct cohorts, each adhering to specific treatment protocols.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethod\u003c/b\u003e\u003c/p\u003e \u003cp\u003e17 premature infants who only received high-frequency ventilation as the control group and 17 premature infants who received high-frequency ventilation\u0026thinsp;+\u0026thinsp;closed-loop automatic oxygen control as the study group. The therapeutic effects and complications of the two groups were compared.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe 2-hour \u0026ldquo;oxygen saturation of blood\u0026rdquo; and 4-hour \u0026ldquo;oxygen saturation of blood\u0026rdquo; in the control group were lower than those in the experimental group ( P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ). The \"PO2\" of the control group after 1 day of treatment was higher than that of the experimental group ( P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ).There was no statistically significant difference in the occurrence of VAP, pulmonary air leakage, pulmonary hemorrhage, grade III-IV intracranial hemorrhage, ROP, and BPD between the two groups ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 ). It is noteworthy that the number of hypoxic interventions in the control group was significantly higher than that in the experimental group, with a p-value less than 0.05.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe use of high-frequency ventilation\u0026thinsp;+\u0026thinsp;closed-loop automatic oxygen control in Premature infants with NRDS has a positive effect on reducing the occurrence of hypoxemia during treatment, which can significantly reduce the number of interventions when hypoxemia occurs. However, there is no significant difference in the occurrence of common long-term complications such as bronchopulmonary dysplasia in premature infants.\u003c/p\u003e","manuscriptTitle":"Application of high-frequency ventilation combined with closed-loop automatic oxygen control therapy in neonatal respiratory distress syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-16 11:30:09","doi":"10.21203/rs.3.rs-4869171/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"acdc291c-9503-4ed0-a68a-b252e124b460","owner":[],"postedDate":"September 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-06T10:53:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-16 11:30:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4869171","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4869171","identity":"rs-4869171","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}