High-frequency ventilation (HFV) in hyaline membrane disease--a preliminary report

Eight premature babies affected by hyaline membrane disease and needing mechanical respiratory support were ventilated by means of a VDR 1 (Bird Space Technology) respirator at 10 Hz during a mean time of 51 h. Before HFV 7 infants had been on conventional mechanical ventilation (CMV) and one on nasal CPAP. The values of mean airway pressure (MAP) and oxygenation index (PaO2/FIO2) on CMV and HFV were (mean and range): CMV: MAP 15 (4-29) mm Hg, ox. index 15.47 (5.07-23.19) kPa; HFV after 1 h: MAP 15 (10-19) mm Hg, ox. index 24.13 (9.07-46.12) kPa. Improved oxygenation allowed rapid reduction of FIO2 in the following hours. Only 3 infants were weaned directly from VDR 1, 5 were switched back to CMV mainly because of technical failures of the respirator. The change from HFV to CMV was associated with a fall of PaO2/FIO2 from 35.99 (15.86-74.52) to 22.39 (7.33-31.46) kPa. The mean time of artificial ventilation (CMV + HFV) was 121 h (range 46-166). Except for 1 pneumothorax no medical complications were seen during HFV, and all patients survived. Despite impressive improvements in oxygenation it is cautioned against the use of the VDR 1 because of the high incidence of technical problems.