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First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without
Vincenzo Salvo1, Luc J Zimmermann, Antonio W Gavilanes
1Department of Maternal, Fetal and Neonatal Medicine, University of Messina, Messina, Italy.
Insights
High-frequency oscillatory ventilation significantly reduced ventilator dependency, reintubation rates, and hospital stays for very low birth weight infants with respiratory distress syndrome when antenatal glucocorticoids were not used.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Critical Care
Background:
- The effectiveness of high-frequency oscillatory ventilation (HFOV) versus conventional mechanical ventilation (CMV) for very low birth weight (VLBW) infants with respiratory distress syndrome (RDS) remains debated.
- Antenatal glucocorticoid prophylaxis is a standard treatment for RDS, but its absence necessitates alternative management strategies.
Purpose of the Study:
- To compare the efficacy of first-intention HFOV versus CMV in VLBW infants with RDS who did not receive antenatal glucocorticoid prophylaxis.
- To evaluate primary and secondary outcomes, including ventilatory support duration, reintubation rates, and length of hospital stay.
Main Methods:
- A multicenter randomized controlled trial was conducted involving 88 VLBW infants with RDS.
- Infants were randomized to receive either HFOV (n=44) or CMV (n=44) as initial ventilatory support.
- Standard monitoring, laboratory variables, neurologic assessments, and ultrasound imaging were employed.
Main Results:
- HFOV significantly reduced ventilator dependency, reintubation rates, and postextubation nasal continuous positive airway pressure support duration compared to CMV.
- VLBW infants treated with HFOV also showed a significantly lower need for repeat surfactant administration and shorter neonatal intensive care unit (NICU) and hospital stays.
- No significant differences were reported for other adverse pulmonary and neonatal outcomes.
Conclusions:
- First-intention HFOV is a beneficial strategy for VLBW infants with severe RDS who have not received antenatal glucocorticoid prophylaxis.
- HFOV reduces the need for ventilatory support, surfactant therapy, and reintubation, while also shortening NICU and hospital stays, potentially lowering healthcare costs.
Objective:
Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are, to date, still matter of debate. We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed.
Design:
Multicenter randomized control trial.
Setting:
Three tertiary centers of neonatal intensive care units from December 2004 to December 2007.
Population:
Eighty-eight very low birth weight infants complicated by respiratory distress syndrome, without antenatal glucocorticoids, supported by first intention high-frequency oscillatory ventilation (n = 44) or conventional mechanical ventilation (n = 44).
Interventions:
All newborns were monitored by standard monitoring procedure, including routine laboratory variables, neurologic patterns, and ultrasound imaging. Primary outcomes were: the length of ventilatory support, the need of reintubation, and the length of nasal continuous positive airway pressure support in the postextubation period. Secondary outcomes were: the length of stay in neonatal intensive care unit and in hospital, death before discharge, adverse short- and long-term pulmonary and neonatal outcomes, and the need for a second dose of surfactant and of postnatal glucocorticoid treatment.
Results:
High-frequency oscillatory ventilation infants showed a significant lower duration (p < .001 for all) of ventilator dependency, lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period. Among secondary outcomes in the high-frequency oscillatory ventilation infants, the need of a second dose of surfactant administration, and the length of stay in the neonatal intensive care unit and in hospital were significantly lower (p < .05 for all).
Conclusions:
We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support, surfactant therapy, and reintubation, and shortened neonatal intensive care unit and hospital stay, thus reducing unit and hospital costs. These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population, such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids.
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