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High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of
Insights
High-frequency oscillatory ventilation did not improve outcomes for preterm infants with respiratory failure compared to conventional mechanical ventilation. It was associated with increased risks of pneumoperitoneum, severe intracranial hemorrhage, and periventricular leukomalacia.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Preterm infants often experience respiratory failure.
- Mechanical ventilation is a common treatment, but high-frequency oscillatory ventilation (HFOV) is an alternative.
- Efficacy and safety of HFOV versus conventional mechanical ventilation (CMV) in this population require further investigation.
Purpose of the Study:
- To compare the efficacy and safety of HFOV versus CMV in preterm infants with respiratory failure.
- To assess differences in bronchopulmonary dysplasia, mortality, and ventilatory support levels.
- To evaluate adverse events associated with each ventilation strategy.
Main Methods:
- Multicenter randomized clinical trial.
- 673 preterm infants (750-2000 g) were randomized to HFOV (n=327) or CMV (n=346).
- Outcomes assessed included bronchopulmonary dysplasia, mortality, ventilatory support, and specific adverse events.
Main Results:
- No significant difference in bronchopulmonary dysplasia (40% vs. 41%, P=0.79) or mortality (18% vs. 17%, P=0.73) between HFOV and CMV groups.
- HFOV showed higher rates of pneumoperitoneum (3% vs. 1%, P=0.05), severe intracranial hemorrhage (26% vs. 18%, P=0.02), and periventricular leukomalacia (12% vs. 7%, P=0.05).
- Crossover from HFOV to CMV was more frequent than from CMV to HFOV (26% vs. 17%, P=0.01).
Conclusions:
- HFOV, as used in this trial, offers no apparent advantage over CMV for preterm infants with respiratory failure.
- HFOV may be associated with an increased risk of serious adverse events, including intracranial hemorrhage and periventricular leukomalacia.
- Further research is needed to optimize ventilation strategies for preterm infants.
Abstract:
We conducted a multicenter randomized clinical trial to compare the efficacy and safety of high-frequency ventilation with that of conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. Of 673 preterm infants weighing between 750 and 2000 g, 346 were assigned to receive conventional mechanical ventilation and 327 to receive high-frequency oscillatory ventilation. The incidence of bronchopulmonary dysplasia was similar in the two groups (high-frequency ventilation, 40 percent; conventional mechanical ventilation, 41 percent; P = 0.79). High-frequency ventilation did not reduce mortality (18 percent, vs. 17 percent with conventional ventilation; P = 0.73) or the level of ventilatory support during the first 28 days. The crossover rate from high-frequency ventilation to conventional mechanical ventilation was greater than the crossover rate from mechanical to high-frequency ventilation (26 vs. 17 percent; P = 0.01). High-frequency ventilation, as compared with conventional mechanical ventilation, was associated with an increased incidence of pneumoperitoneum of pulmonary origin (3 vs. 1 percent; P = 0.05), grades 3 and 4 intracranial hemorrhage (26 vs. 18 percent; P = 0.02), and periventricular leukomalacia (12 vs. 7 percent; P = 0.05). These results suggest that high-frequency oscillatory ventilation, as used in this trial, does not offer any advantage over conventional mechanical ventilation in the treatment of respiratory failure in preterm infants, and it may be associated with undesirable side effects.