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Pulmonary function in preterm infants whose lungs were ventilated conventionally or by high-frequency oscillation
T Gerhardt1, L Reifenberg, R N Goldberg
1Department of Pediatrics, University of Miami School of Medicine, Florida 33101.
Insights
High-frequency oscillatory ventilation did not reduce chronic lung damage in preterm infants compared to intermittent mandatory ventilation. Lung function remained similar between groups, showing no benefit of HFOV for preventing pulmonary damage.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Preterm infants requiring mechanical ventilation are at high risk for chronic pulmonary damage.
- High-frequency oscillatory ventilation (HFOV) is hypothesized to reduce barotrauma and subsequent lung injury.
- Evaluating the long-term effects of different ventilation strategies is crucial for improving outcomes in vulnerable infants.
Purpose of the Study:
- To investigate whether high-frequency oscillatory ventilation (HFOV) reduces the incidence of chronic pulmonary damage in preterm infants compared to intermittent mandatory ventilation (IMV).
- To assess lung function before discharge in preterm infants randomized to HFOV or IMV.
Main Methods:
- A randomized controlled trial involving 53 preterm infants requiring mechanical ventilation from the first day of life.
- Infants were assigned to either intermittent mandatory ventilation (IMV) or high-frequency oscillatory ventilation (HFOV).
- Lung function, including lung compliance, pulmonary resistance, and functional residual capacity, was measured before discharge using pneumotachygraphy, esophageal pressure, and N2 washout.
Main Results:
- No significant differences were observed between the IMV and HFOV groups in birth weight, gestational age, initial ventilatory support, duration of ventilation, or oxygen therapy.
- Both groups exhibited abnormal lung function, characterized by decreased lung compliance and elevated pulmonary resistance.
- Functional residual capacity was within the normal range for both treatment groups, with no significant differences in lung function parameters between HFOV and IMV.
Conclusions:
- The study does not support the hypothesis that high-frequency oscillatory ventilation (HFOV) reduces the risk of chronic lung damage in preterm infants.
- Lung function outcomes were similar between infants treated with HFOV and those treated with intermittent mandatory ventilation (IMV).
- Further research may be needed to explore alternative ventilation strategies or adjunctive therapies for preventing lung injury in mechanically ventilated preterm infants.
Abstract:
To test the hypothesis that high-frequency ventilation may reduce the risk of barotrauma and thus the incidence of chronic pulmonary damage in preterm infants who need mechanical ventilation, we measured lung function before discharge in 53 infants who needed mechanical ventilation on the first day after birth and were randomly assigned to receive intermittent mandatory ventilation (n = 26) or to receive high-frequency oscillatory ventilation (n = 27). There were no significant differences between the groups in birth weight (mean +/- SD: 1010 +/- 240 vs 1030 +/- 230 gm), gestational age (29.1 +/- 2.0 vs 28.9 +/- 2.1 weeks), initial ventilatory support (mean airway pressure 7.2 +/- 1.8 vs 8.1 +/- 2.1 cm H2O; FiO2 0.62 +/- 0.24 vs 0.75 +/- 0.22), duration of mechanical ventilation (median (range): 6 (1 to 61) vs 10 (1 to 50) days) and duration of oxygen therapy (13 (1 to 109) vs 27 (4 to 227) days) for the intermittent mandatory ventilation group and the high-frequency oscillatory ventilation group, respectively. At the time of testing, weight was 1830 +/- 340 vs 1830 +/- 290 gm, and age was 68 +/- 24 vs 70 +/- 31 days. Respiratory flows were determined by pneumotachygraphy, esophageal pressure through a water-filled feeding tube, and functional residual capacity by N2 washout. Both groups had abnormal lung function with decreased lung compliance (1.65 +/- 0.51 vs 1.54 +/- 0.36 ml/cm H2O) and elevated pulmonary resistance (102 +/- 24 vs 107 +/- 36 cm H2O/L/sec). Functional residual capacity was in the normal range (30.6 +/- 6.0 vs 28.2 +/- 10.7 ml) in both groups. There were no significant differences in lung function between the two treatment groups. These results do not support the hypothesis that high-frequency oscillatory ventilation reduces the risk of lung damage in preterm infants.