High-frequency ventilation in neonates

To provide a brief review of the current status of high-frequency ventilation in neonatal respiratory care.

Publications appearing between 1980 and 1990 were identified by computer searches using the National Library of Medicine's data base, MEDLINE, and by searching bibliographies of identified articles.

Studies related to physiologic background and clinical reports of neonatal application were selected individually.

Data concerning the physiologic basis, clinical effectiveness and complications, and latest results of a multicenter randomized trial were evaluated and used to develop a current concept.

In early clinical tests of high-frequency ventilation, it was considered beneficial that airway pressure lower than that used in conventional mechanical ventilation might reduce the frequency of pulmonary barotrauma. When high-frequency ventilation was applied to infants with respiratory distress syndrome, the development of chronic pulmonary complications also was expected to decrease. Although several reports supported this hypothesis, a recent controlled trial involving multiple clinical centers did not find significant improvement in the group treated with high-frequency ventilation. Rather, they recognized the frequent occurrence of complications associated with high-frequency ventilation and suggested the prior use of conventional ventilation. However, a possible defect of this study design requires further studies to elucidate the source of these conflicting results.

As a mode of mechanical ventilation, high-frequency ventilation is useful for maintaining ventilation in patients with air leak syndrome or bronchopulmonary fistula or during bronchoscopic examination. But in general, its role as an alternative to conventional ventilation still remains controversial.