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Published on: July 9, 2020
High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants
Sherry E Courtney1, David J Durand, Jeanette M Asselin
1Division of Neonatology, Cooper Hospital-University Medical Center, Camden, NJ, USA. scourtney@lij.edu.
Insights
Early high-frequency oscillatory ventilation (HFOV) improved pulmonary outcomes for very low birth weight infants. This ventilation strategy showed a significant benefit without increasing complications compared to synchronized intermittent mandatory ventilation.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Critical Care
Background:
- Efficacy and safety of early high-frequency oscillatory ventilation (HFOV) versus conventional synchronized intermittent mandatory ventilation (SIMV) in very low birth weight (VLBW) infants remain unclear.
- VLBW infants often require mechanical ventilation, necessitating optimized respiratory support strategies.
Purpose of the Study:
- To compare the effectiveness of early HFOV versus SIMV in VLBW infants.
- To determine if early HFOV improves survival without supplemental oxygen at 36 weeks postmenstrual age.
Main Methods:
- A randomized, multicenter clinical trial involving 500 VLBW infants (601-1200g birth weight).
- Infants received surfactant and required mechanical ventilation (mean airway pressure ≥ 6 cmH2O, FiO2 ≥ 0.25).
- Random assignment to either HFOV or SIMV groups, stratified by birth weight and prenatal corticosteroid exposure.
Main Results:
- Infants in the HFOV group were extubated significantly earlier (P<0.001).
- 56% of HFOV infants survived without supplemental oxygen at 36 weeks postmenstrual age, versus 47% in the SIMV group (P=0.046).
- No significant differences in intracranial hemorrhage, cystic periventricular leukomalacia, or other complications were observed between groups.
Conclusions:
- Early HFOV offers a small but significant pulmonary benefit for VLBW infants.
- HFOV is a safe alternative to SIMV, without increasing adverse outcomes in this population.
Background:
The efficacy and safety of early high-frequency oscillatory ventilation as compared with conventional synchronized intermittent mandatory ventilation for the treatment of infants with very low birth weight have not been established.
Methods:
We conducted a randomized, multicenter clinical trial to determine whether infants treated with early high-frequency oscillatory ventilation were more likely than infants treated with synchronized intermittent mandatory ventilation to be alive without requiring supplemental oxygen at 36 weeks of postmenstrual age. Eligible infants weighed 601 to 1200 g at birth, were less than four hours of age, had received one dose of surfactant, and required ventilation with a mean airway pressure of at least 6 cm of water and a fraction of inspired oxygen of at least 0.25. Infants were stratified according to birth weight and exposure to prenatal corticosteroids and then randomly assigned to high-frequency oscillatory ventilation or synchronized intermittent mandatory ventilation. Ventilation was managed according to protocols designed to optimize lung inflation and blood gas values.
Results:
Five hundred infants were enrolled in the study. Infants randomly assigned to high-frequency oscillatory ventilation were successfully extubated earlier than infants assigned to synchronized intermittent mandatory ventilation (P<0.001). Of infants assigned to high-frequency oscillatory ventilation, 56 percent were alive without a need for supplemental oxygen at 36 weeks of postmenstrual age, as compared with 47 percent of those receiving synchronized intermittent mandatory ventilation (P=0.046). There was no difference between the groups in the risk of intracranial hemorrhage, cystic periventricular leukomalacia, or other complications.
Conclusions:
There was a small but significant benefit of high-frequency oscillatory ventilation in terms of the pulmonary outcome for very-low-birth-weight infants without an increase in the occurrence of other complications of premature birth.
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