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Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in
M Keszler1, S M Donn, R L Bucciarelli
1Department of Pediatrics, Georgetown University, Washington, D.C.
Insights
High-frequency jet ventilation (HFJV) is more effective than conventional mechanical ventilation (CV) for treating newborn infants with pulmonary interstitial emphysema, showing better treatment success and radiographic improvement.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Pulmonary interstitial emphysema (PIE) is a serious condition in newborn infants.
- Conventional mechanical ventilation (CV) can have limitations in treating severe PIE.
Purpose of the Study:
- To compare the efficacy and safety of high-frequency jet ventilation (HFJV) versus rapid-rate conventional mechanical ventilation (CV) in neonates with PIE.
Main Methods:
- 144 newborn infants with PIE were randomized to HFJV or CV.
- Crossover to alternate ventilation was allowed for treatment failure.
- Outcomes included treatment success, radiographic improvement, and survival.
Main Results:
- HFJV achieved higher treatment success rates (61%) compared to CV (37%).
- HFJV led to faster radiographic improvement and lower airway pressures.
- Survival rates, excluding rescue therapy, were higher for HFJV (64.9%) than CV (47.1%).
Conclusions:
- HFJV is a safe and more effective treatment for neonatal pulmonary interstitial emphysema than rapid-rate CV.
- HFJV offers significant benefits in ventilation, radiographic outcomes, and survival for this patient population.
Abstract:
One hundred forty-four newborn infants with pulmonary interstitial emphysema were stratified by weight and severity of illness, and randomly assigned to receive treatment with high-frequency jet ventilation (HFJV) or rapid-rate conventional mechanical ventilation (CV) with short inspiratory time. If criteria for treatment failure were met, crossover to the alternate ventilatory mode was permitted. Overall, 45 (61%) of 74 infants met treatment success criteria with HFJV compared with 26 (37%) of 70 treated with CV (p less than 0.01). Eighty-four percent of patients who crossed over from CV to HFJV initially responded to the new treatment, and 45% ultimately met success criteria on HFJV. In contrast, only 9% of those who crossed over from HFJV to CV responded well to CV (p less than 0.01), and the same 9% ultimately met success criteria (p less than 0.05). Therapy with HFJV resulted in improved ventilation at lower peak and mean airway pressures, as well as more rapid radiographic improvement of pulmonary interstitial emphysema, in comparison with rapid-rate CV. Survival by original assignment was identical. When survival resulting from rescue by the alternate therapy in crossover patients was excluded, the survival rate was 64.9% for HFJV, compared with 47.1% for CV (p less than 0.05). The incidence of chronic lung disease, intraventricular hemorrhage, patent ductus arteriosus, airway obstruction, and new air leak was similar in both groups. We conclude that HFJV, as used in this study, is safe and is more effective than rapid-rate CV in the treatment of newborn infants with pulmonary interstitial emphysema.