Elective HFOV vs CMV as Early Intervention: A Clinical Trial in Neonates with Acute Respiratory Distress Syndrome

While Synchronized Intermittent Mandatory Ventilation with Volume Guarantee (SIMV + VG) is commonly used for mechanical ventilation in preterm infants with respiratory failure, High-Frequency Oscillatory Ventilation (HFOV) is often reserved for cases unresponsive to conventional modes. Given the inconclusive findings on the early HFOV, this trial compares SIMV + VG and HFOV as initial ventilation strategies in preterm infants with respiratory distress syndrome (RDS).

This randomized controlled trial included 86 neonates (25-35 weeks' gestation) with RDS, enrolled from 2020 to 2023 at two tertiary referral hospitals affiliated with Isfahan University of Medical Sciences, Iran. Using stratified block randomization by birth weight, neonates were assigned to either the HFOV or SIMV + VG group (n = 43 each). Primary outcomes included total intubation duration, Non-Invasive Positive Pressure Ventilation (NIPPV) duration, and total oxygen therapy duration. Secondary outcomes included hospitalization duration and the incidence of complications such as Bronchopulmonary Dysplasia (BPD), Intraventricular Hemorrhage (IVH), and Retinopathy of Prematurity (ROP).

The HFOV group showed significantly shorter intubation duration (3.80 vs. 8.62 days, P = 0.02) and NIPPV duration (5.63 vs. 7.86 days, P = 0.017), and lower BPD incidence (21.2% vs. 46.7%, P = 0.032). Differences in oxygen therapy, hospitalization duration, and other complications were not statistically significant.

Early HFOV application in preterm neonates with RDS significantly reduces intubation duration, NIPPV duration, and BPD incidence. These findings suggest potential benefits of HFOV in improving neonatal outcomes. Further multi-center studies with long-term follow-up are warranted to validate these results and explore broader clinical implications.