Childhood Outcome After Early High-Frequency Oscillatory Ventilation for Neonatal Respiratory Distress Syndrome

Gerstmann, Dale R.; Wood, Kari; Miller, Annie; Steffen, Mike; Ogden, Bob; Stoddard, Ronald A.; Minton, Stephen D.

doi:10.1542/peds.108.3.617

Cited by 96 publications

(133 citation statements)

References 23 publications

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“…Some studies suggest a modest reduction in CLD in survivors, but with no reduction in short-term neurological outcomes. Two high-frequency rescue trials, one with HFOV and one with HFJV, failed to show a reduction in the need for extracorporeal membrane oxygenation therapy in eligible infants, 33,34 although HFOV seems to be a better rescue strategy than IMV. 35 Concern over an increased incidence in intracranial hemorrhage has been expressed.…”

Section: Clinical Evidencementioning

confidence: 99%

Neonatal ventilators: how do they differ?

Donn

2009

J Perinatol

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Remarkable technological advances over the past two decades have brought dramatic changes to the neonatal intensive care unit. Microprocessor-based mechanical ventilation has replaced time-cycled, pressure-limited, intermittent mandatory ventilation with almost limitless options for the management of respiratory failure in the prematurely born infant. Unfortunately, much of the infusion of technology occurred before the establishment of a convincing evidence base. This review focuses on the basic principles of mechanical ventilation, nomenclature and the characteristics of both conventional and high-frequency devices.

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Section: Clinical Evidencementioning

confidence: 99%

Neonatal ventilators: how do they differ?

Donn

2009

J Perinatol

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“…The decision to use high-frequency ventilation was neonatologist-dependent, and generally, more immature infants were provided with highfrequency ventilation. Mean airway pressure was usually set 1 to 2 cm H 2 O above the mean airway pressure on conventional mechanical ventilation, 20,21 amplitude was increased until appropriate chest movement was noticed, and the frequency was set between 10 and 12 Hz. During the study period, a permissive hypercapnic ventilation strategy (with a PaCO 2 target range of 45 to 55 mm Hg) was used.…”

Section: Study Samplementioning

confidence: 99%

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

2007

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Objectives: Examining the effects of tracheal suctioning on cerebral hemodynamics of normotensive ventilated very low birth weight (VLBW) infants with normal cranial ultrasounds; determining the factor(s) influencing changes in mean cerebral blood flow velocity (CBFv) after suctioning.Methods: Seventy-three VLBW infants had continuous monitoring of mean arterial blood pressure (MABP), PaCO 2 , PaO 2 and mean CBFv before, during, and after 202 suctioning sessions during the first week of life. Peak (or nadir) and relative changes of the four variables for 45 min after suctioning were calculated. Multiple linear regression was used to determine the factor(s) influencing changes in mean CBFv after suctioning.Result: Birth weight was 928 ± 244 g; gestational age was 27.0 ± 2.0 weeks. Mean CBFv increased to 31.0 ± 26.4% after suctioning and remained elevated for 25 min. PaCO 2 was highly associated with mean CBFv (P<0.001), whereas MABP and PaO 2 were not. Conclusion:We observed prolonged increases of mean CBFv following suctioning in ventilated VLBW infants that were previously unrecognized. This is concerning since disturbances of CBF may be associated with subsequent brain injury.

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“…Efforts to decrease the incidence of BPD have included attempts to avoid mechanical ventilation with the use of continuous positive airway pressure (3), different techniques for mechanical ventilation such as high-frequency oscillatory ventilation (4), and lower VT ventilation resulting in higher PCO 2 values (5). In the mature lung, ventilator-mediated injury increases if the lung is inadequately inflated at end-expiration or overinflated at end-inspiration (6,7).…”

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confidence: 99%

Effects of High Pco2 on Ventilated Preterm Lamb Lungs

2003

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High PCO 2 levels attenuate reperfusion injury and ventilationinduced injury in isolated and perfused lungs. We asked whether premature lambs could tolerate 6 h of ventilation with a PCO 2 Ͼ80 mm Hg and whether the high PCO 2 modulated the ventilatorinduced injury. Preterm surfactant-treated lambs were ventilated for 30 min with a high tidal volume (VT) to induce lung injury. The lambs then were ventilated for 5.5 h with a VT of 6 -9 mL/kg to achieve a PCO 2 of 40 -50 mm Hg in the control group. CO 2 was added to the ventilator circuit of a high PCO 2 group to maintain an average PCO 2 of 95 Ϯ 5 mm Hg. The high PCO 2 lambs had heart rates, blood pressures, plasma cortisol values, and oxygenation equivalent to the control lambs. The lungs of the high PCO 2 group had significantly higher gas volumes and had less lung injury by histopathology. Indicators of inflammation (white blood cells, hydrogen peroxide production, and IL-1␤ and IL-8 cytokine mRNA expression in cells from the alveolar wash) qualitatively indicated less injury in the high PCO 2 group, although the differences were not significant. Preterm lambs tolerated a very high PCO 2 without physiologic compromise for 6 h. The high PCO 2 may attenuate ventilator-induced lung injury in the preterm. BPD in preterm infants is highly associated with the use of mechanical ventilation and supplemental oxygen (1, 2). Efforts to decrease the incidence of BPD have included attempts to avoid mechanical ventilation with the use of continuous positive airway pressure (3), different techniques for mechanical ventilation such as high-frequency oscillatory ventilation (4), and lower VT ventilation resulting in higher PCO 2 values (5). In the mature lung, ventilator-mediated injury increases if the lung is inadequately inflated at end-expiration or overinflated at end-inspiration (6, 7). Attempts to decrease lung distention by decreasing VT will result in increases in PCO 2 , referred to as "permissive hypercapnia" (8). Laffey et al. (9) recently extended this concept to "therapeutic hypercapnia" by demonstrating that reperfusion injury of the lung can be prevented if the injury and reperfusion occur in the presence of a PCO 2 of 80 mm Hg. This work demonstrates that high PCO 2 can protect the lung from reperfusion injury, most likely via attenuation of free radical damage. This effect has also been reported for reperfusion injury of other organ systems, such as the brain and heart in adult and newborn animal models (10, 11). Broccard et al. (12) recently reported that high PCO 2 also minimized ventilatorinduced lung injury in isolated and perfused lungs. However, a protective effect of high PCO 2 values has not been demonstrated for ventilator-induced injury in vivo in animals or for the preterm lung. Therefore, we ventilated surfactant-treated preterm lambs to achieve normal PCO 2 values or equivalently ventilated other lambs with supplemental CO 2 to evaluate the tolerance of the preterm to high PCO 2 and the effect of the high PCO 2 on indicators of lung injury. MET...

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Childhood Outcome After Early High-Frequency Oscillatory Ventilation for Neonatal Respiratory Distress Syndrome

Cited by 96 publications

References 23 publications

Neonatal ventilators: how do they differ?

Neonatal ventilators: how do they differ?

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

Effects of High Pco2 on Ventilated Preterm Lamb Lungs

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