{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T02:27:53Z","timestamp":1791167273296,"version":"4.1.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    This study aims to evaluate the relationship between ventilator-derived carbon dioxide clearance and arterial CO\n                    <jats:sub>2<\/jats:sub>\n                    elimination during high-frequency oscillatory ventilation with volume guarantee (HFOV-VG), and to examine determinants and clinical relevance of ventilatory efficiency. In this cohort study, preterm infants less than 30\u00a0weeks of gestation receiving HFOV-VG were studied during the first 72\u00a0h after birth. Minute-level ventilator data were paired with arterial blood gases. Ventilatory efficiency was defined as weight-normalised DCO\n                    <jats:sub>2<\/jats:sub>\n                    divided by arterial PCO\n                    <jats:sub>2<\/jats:sub>\n                    . Temporal patterns and determinants were analysed using generalised estimating equations. The clinical outcome was death or moderate-to-severe bronchopulmonary dysplasia (BPD). A total of 185,018 ventilator observations and 595 paired ventilator\u2013blood gas measurements from 60 infants were analysed. Arterial PCO\n                    <jats:sub>2<\/jats:sub>\n                    remained stable (50 [43\u201356] mmHg) despite wide variation in DCO\n                    <jats:sub>2<\/jats:sub>\n                    (34.6 [27.1\u201347.8]). Ventilatory efficiency varied between infants (0.72 [0.55\u20130.98]) and demonstrated a temporal pattern, decreasing from 0.77 (0.61\u20130.90) at 0\u20136\u00a0h to 0.65 (0.45\u20130.80) at 6\u201312\u00a0h and increasing to 0.76 (0.56\u20131.07) at 24\u201348\u00a0h. Higher efficiency was associated with higher oscillatory frequency (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Death or moderate-to-severe BPD occurred in 85.0%, 70.0%, and 45.0% across low, intermediate-, and high-efficiency tertiles, respectively. Ventilatory efficiency demonstrated moderate discrimination for the composite outcome (AUC 0.69), improving to 0.76 with FiO\n                    <jats:sub>2<\/jats:sub>\n                    and mean airway pressure.\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0During HFOV-VG, ventilator-derived CO\n                    <jats:sub>2<\/jats:sub>\n                    clearance showed limited correspondence with arterial PCO\n                    <jats:sub>2<\/jats:sub>\n                    . Ventilatory efficiency had moderate discrimination for adverse respiratory outcomes.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>During high-frequency oscillatory ventilation, ventilator-derived indices such as oscillatory tidal volume and DCO2 are commonly used to guide carbon dioxide clearance.<\/jats:italic>\n                              \u2022\n                              <jats:italic>The relationship between ventilator-derived carbon dioxide transport and effective arterial CO2 elimination during HFOV with volume guarantee remains incompletely understood.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Ventilatory efficiency provides a physiological measure integrating ventilator-derived carbon dioxide transport and arterial CO2 elimination during HFOV with volume guarantee, a relationship that is not routinely evaluated in clinical practice.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Ventilatory efficiency demonstrated modest discrimination for death or moderate-to-severe bronchopulmonary dysplasia, with discrimination improving when combined with markers of respiratory support intensity.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07188-8","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T23:53:11Z","timestamp":1782431591000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ventilatory efficiency during high-frequency oscillatory ventilation with volume guarantee in preterm infants"],"prefix":"10.1007","volume":"185","author":[{"given":"Kamal","family":"Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesaed","family":"Alsenani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Alshareedah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"Alamer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Alberti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Homedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"Alsaif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Dassios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Greenough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"issue":"3 Suppl","key":"7188_CR1","doi-asserted-by":"publisher","first-page":"S135","DOI":"10.1097\/01.CCM.0000155789.52984.B7","volume":"33","author":"JJ Pillow","year":"2005","unstructured":"Pillow JJ (2005) High-frequency oscillatory ventilation: mechanisms of gas exchange and lung mechanics. 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Ethical approval for retrospective data collection and analysis was obtained from the King Abdullah International Medical Research Centre (KAIMRC). Given the retrospective nature of this study and the use of fully de-identified clinical data, the requirement for informed consent was waived.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"527"}}