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Comparison of pulmonary inflammatory mediators in preterm infants treated with intermittent positive pressure
U Thome1, B Götze-Speer, C P Speer
1Department of Pediatrics, University of Ulm, Germany.
Insights
High frequency oscillatory ventilation (HFOV) did not reduce inflammatory markers in preterm infants compared to intermittent positive pressure ventilation (IPPV). This study found no significant differences in albumin, IL-8, or LTB4 levels between the two ventilation methods.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Preterm infants on mechanical ventilation are at risk for bronchopulmonary dysplasia due to increased inflammatory mediators.
- High frequency oscillatory ventilation (HFOV) is hypothesized to be less traumatic than intermittent positive pressure ventilation (IPPV), potentially reducing inflammation.
Purpose of the Study:
- To compare the inflammatory response in tracheal aspirates of preterm infants ventilated with HFOV versus a high-rate, low-pressure IPPV.
Main Methods:
- Seventy-six preterm infants requiring mechanical ventilation were randomized to either IPPV or HFOV within 1 hour of intubation.
- Tracheal aspirates were collected for 10 days and analyzed for albumin, IL-8, and leukotriene B4 (LTB4), normalized to secretory component for IgA.
- Bacterially colonized samples were excluded from analysis.
Main Results:
- Median concentrations of albumin, IL-8, and LTB4 in tracheal aspirates were measured on days 1, 3, 5, 7, and 10.
- No significant differences in albumin, IL-8, or LTB4 levels were observed between the IPPV and HFOV groups throughout the study period.
Conclusions:
- High frequency oscillatory ventilation (HFOV) does not appear to reduce the measured inflammatory markers (albumin, IL-8, LTB4) in tracheal aspirates of ventilated preterm infants compared to high-rate, low-pressure IPPV.
- Further research may be needed to explore other ventilation strategies or adjunctive therapies for reducing inflammation in this vulnerable population.
Abstract:
Ventilated preterm infants prone to the development of bronchopulmonary dysplasia have been shown to have increased inflammatory mediators in their tracheal aspirates. High frequency oscillatory ventilation (HFOV) is thought to be less traumatic than intermittent positive pressure ventilation (IPPV) in premature infants with surfactant deficiency, and therefore may reduce the inflammatory response in tracheobronchial aspirates. We randomized 76 premature infants requiring mechanical ventilation (birth weight 420-1830 g, median 840 g, gestational age 23 3/7 to 29 2/7 wk, median 26 4/7 to receive either an IPPV with a high rate (60-80/min) and low peak pressures, or an HFOV aiming at an optimization of lung volume, within 1 h of intubation. Tracheal aspirates were systematically collected during the first 10 d of life and analyzed for albumin, IL-8, leukotriene B4 (LTB4), and the secretory component (SC) for IgA as a reference protein. Bacterially colonized samples were excluded. On the treatment d 1, 3, 5, 7, and 10, the resulting median values of albumin (milligrams/mg of SC) were 28, 23, 24, 18, and 10, in IPPV-ventilated infants, and 33, 28, 18, 25, and 39 in HFOV-ventilated infants, respectively. Median IL-8 values (nanograms/mg of SC) were 671, 736, 705, 1362, and 1879 (IPPV) and 874, 1713, 1029, 1426, and 1823 (HFOV), respectively, and median LTB4 values (nanograms/mg of SC) were 26, 13, 27, 22, and 11 (IPPV) and 15, 12, 7, 12, and 16 (HFOV), respectively. Values were similar in IPPV- and HFOV-ventilated infants, and no significant differences were noted. We conclude that HFOV, when compared with a high rate low pressure IPPV, does not reduce concentrations of albumin, IL-8, and LTB4 in tracheal aspirates of preterm infants requiring mechanical ventilation.