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Effects of pressure support ventilation plus volume guarantee vs. high-frequency oscillatory ventilation on lung
Carlo Dani1, Giovanna Bertini, Marco Pezzati
1Section of Neonatology, Department of Surgical and Medical Critical Care, Careggi University Hospital of Florence, Florence, Italy. cdani@unifi.it
Insights
High-frequency oscillatory ventilation (HFOV) reduced lung inflammation in preterm infants with infant respiratory distress syndrome (RDS) compared to pressure support ventilation plus volume guarantee (PSV + VG). This lung-protective strategy offers a potential benefit for premature neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Infant respiratory distress syndrome (RDS) is a common condition in preterm infants.
- Mechanical ventilation is often required for RDS management.
- Lung-protective ventilation strategies aim to minimize ventilator-induced lung injury.
Purpose of the Study:
- To compare the efficacy of high-frequency oscillatory ventilation (HFOV) versus pressure support ventilation plus volume guarantee (PSV + VG) in reducing lung inflammation.
- To evaluate the impact of these ventilation strategies on inflammatory markers in preterm infants with RDS.
Main Methods:
- A randomized controlled trial involving preterm infants (<30 weeks gestation) with RDS requiring mechanical ventilation.
- Infants were allocated to either HFOV or PSV + VG.
- Bronchial aspirate samples were collected at multiple time points to measure interleukin (IL)-1beta, IL-8, and IL-10 levels.
Main Results:
- Mean levels of IL-1beta, IL-8, and IL-10 were significantly lower at extubation (T4) in the HFOV group compared to the PSV + VG group.
- This suggests a reduction in lung inflammation with HFOV.
Conclusions:
- Early application of HFOV is associated with reduced lung inflammation in preterm infants with RDS.
- HFOV may be a more effective lung-protective strategy than PSV + VG in this population.
Abstract:
The aim of the present study was to evaluate if high-frequency oscillatory ventilation (HFOV) might reduce lung inflammation in preterm infants with infant respiratory distress syndrome (RDS) in comparison with the early application of another potentially lung-protective ventilation strategy, such as pressure support ventilation plus volume guarantee (PSV + VG). Infants at less than 30 weeks of gestation with RDS were enrolled consecutively in the study if they required mechanical ventilation, and were randomly allocated to receive HFOV or PSV + VG. Bronchial aspirate samples for the measurement of interleukin (IL)-1beta, IL-8, and IL-10 were obtained before surfactant treatment (T1), after 6-18 hr of ventilation (T2), after 24-48 hr of ventilation (T3), and before extubation (T4). Thirteen patients were enrolled in the HFOV group, and 12 in the PSV + VG group. The mean values of IL-1beta, IL-8, and IL-10 at T4 were lower in the HFOV group than in the PSV + VG group. The present study demonstrates that early treatment with HFOV is associated with a reduction of lung inflammation in comparison with PSV + VG in preterm infants with RDS.
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