High-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation plus pressure support in preterm infants with severe respiratory distress syndrome.

Abstract

BACKGROUND:

Mechanical ventilation and surfactants are the standard treatment of preterm respiratory distress syndrome (RDS). The effects of the primary ventilation model on bronchopulmonary dysplasia (BPD) and long-term neurodevelopment outcomes are controversial. The purpose of this study was to compare the efficacy and safety of high-frequency oscillatory ventilation (HFOV) and synchronized intermittent mandatory ventilation plus pressure support ventilation (SIMV-PSV) in preterm infants with severe RDS.

METHODS:

A total of 366 eligible preterm infants were randomly assigned to treatment with HFOV (n = 184) or SIMV-PSV (n = 182). Surfactant was applied if PaO2/FIO2 was < 200 mm Hg after 2 hours of ventilation. Primary outcomes were mortality or incidence of BPD. Secondary outcomes were duration of ventilation and hospitalization, surfactant requirements, pneumothorax, retinopathy of prematurity ≥ stage 2, and neurodevelopment at 18 months of corrected age.

RESULTS:

Survival and complete outcome data were available for 288 infants at 18 months of corrected age. The incidence of death or BPD was significantly higher in the SIMV-PSV group (P = .001). The duration of mechanical ventilation and hospitalization was shorter and the incidence of surfactant requirement and retinopathy of prematurity was lower in the HFOV group (P < .001, P = .002, P = .04, respectively). Moderate or severe neurological disability was less frequent in the HFOV group than in the SIMV-PSV group at 18 months (P = .03). The combination of HFOV and surfactant dramatically reduced negative outcomes in preterm infants with severe RDS.

CONCLUSIONS:

Initial ventilation with HFOV in preterm infants with severe RDS reduces the incidence of death and BPD, and improves long-term neurodevelopment outcomes. (ClinicalTrials.gov NCT01496508).

• Authors: Huiqing Sun, Rui Cheng, Wengqing Kang, Hong Xiong, Chongchen Zhou, Yinghui Zhang, Xiaoyang Wang, Changlian Zhu
• Journal: Respiratory care (Respir Care) Vol. 59 Issue 2 Pg. 159-69 (Feb 2014) ISSN: 1943-3654 [Electronic] United States
• PMID: 23764865 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Bronchopulmonary Dysplasia (etiology, prevention & control)
• Female
• Gestational Age
• High-Frequency Ventilation
• Humans
• Infant, Newborn
• Infant, Premature
• Infant, Very Low Birth Weight
• Intermittent Positive-Pressure Ventilation
• Male
• Outcome Assessment, Health Care
• Patient Safety
• Respiratory Distress Syndrome, Newborn (complications, mortality, therapy)