Elective High-Frequency Oscillatory Ventilation versus Conventional Ventilation for Acute Pulmonary Dysfunction in Preterm Infants

Cho, Sung-Il; Chang, Yoon Hwan; Kim, Beyong Il; Choi, Jung‐Hwan; Jo, Heui Seung; Bromiker, Ruben; Ernest, Netanela; Meir, Maskit Bar; Kaplan, Michael; Hammerman, Cathy; Schimmel, Michael S.; Breindahl, Morten; Blennow, Mats; Fauchère, Jean‐Claude; Lluch, M. Thió; Luca, Danièle De; Marlow, Neil; Picaud, Jean‐Charles; Roehr, Charles Christoph; Vanpée, Mireille; Vilamor, Eduardo; Zaharie, Gabriela; Greisen, Gorm; Dührsen, Lasse; Simons, Sinno H P; Dzietko, Mark; Genz, Kerstin; Bendix, Ivo; Boos, Vinzenz; Sifringer, Marco; Tibboel, Dick; Felderhoff‐Mueser, Ursula; Schlesinger, Yechiel; Maas, Christoph; Mitt, S.; Full, A.; Arand, Joerg; Bernhard, Wolfgang; Poets, CF; Franz, Axel; Spoel, Marjolein; Ven, Kees P. van de; Tiddens, Harm A.W.M.; Hop, Wim C. J.; Wijnen, René; IJsselstijn, Hanneke; Agarwal, Ramesh K.; Virmani, Deenanath; Jaipal, Munnalal; Gupta, Sudheer; Sankar, Mari Jeeva; Agarwal, Anand; Devgan, Veena; Deorari, Ashok K.; Paul, Vinod K.; Toteja, Gurudayal Singh; Soll, Roger F.; Prusa, Andrea‐Romana; Kasper, David C.; Olischar, Monika; Husslein, Peter; Pollak, Arnold; Hayde, Michael; Bhatia, Sunita; Kim, Ee Kyung; Lee, Kyeung-Yeup; Lee, Hyun Ju; Lee, Jin A; Choi, Chang Won; Kim, Han-Suk; Benders, Manon J. N. L.; Hendrikse, Jeroen; Vries, Linda de; Groenendaal, Floris; Bel, Frank van; McElroy, Steven J.; Underwood, Mark A.; Sherman, Michael P.; Mengensatzproduktion, Satz; Basel, Druck Reinhardt Druck

doi:10.1159/000338553

Cited by 16 publications

(3 citation statements)

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“…The FiO 2 needed is strongly correlated with an infant's current condition as well as being an important predictor of ventilation difficulties [27]. Herein lies, at the same time, the biggest point of criticism, as FiO 2 does not reflect intrinsic risk exclusively, but also the physician's attitude and skills, hospital policy regarding targeted oxygen saturation levels [28] (currently under discussion [19,20]) and the different ventilation modes used in premature infants [18,29,30]. …”

Section: Discussionmentioning

confidence: 99%

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

et al. 2015

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Background: Comparing outcomes at different neonatal intensive care units (NICUs) requires adjustment for intrinsic risk. The Clinical Risk Index for Babies (CRIB) is a widely used risk model, but it has been criticized for being affected by therapeutic decisions. The Prematurity Risk Evaluation Measure (PREM) is not supposed to be prone to treatment bias, but has not yet been validated. Objectives: We aimed to validate the PREM, compare its accuracy to that of the original and modified versions of the CRIB and CRIB-II, and examine the congruence of risk categorization. Methods: Very-low-birth-weight (VLBW) infants with a gestational age (GA) <33 weeks, who were admitted to NICUs in Baden-Württemberg from 2003 to 2008, were identified from the German neonatal quality assurance program. CRIB, CRIB-II and PREM scores were calculated and modified. Omitting variables that directly reflected therapeutic decisions [the applied fraction of inspired oxygen (FiO₂)] or that may have been prone to early-treatment bias (base excess and temperature), non-NICU-therapy-influenced scores were obtained. Score performance was assessed by the area under their ROC curve (AUC). Results: The CRIB showed the largest AUC (0.89), which dropped significantly (to 0.85) after omitting the FiO₂. The PREM birth condition model, PREM(bcm) (AUC 0.86), and the PREM birth model, PREM(bm) (AUC 0.82), also demonstrated good discrimination. PREM(bm) was superior to other non-therapy-affected scores and to GA, particularly in infants with <750 g birth weight. Congruence of risk categorization was low, especially among higher-risk cases. Conclusions: The CRIB score had the largest AUC, resulting from its inclusion of FiO₂. PREM(bm), as the most accurate score among those unaffected by early treatment, seems to be a good alternative for strict risk adjustment in NICU auditing. It could be useful to combine scores.

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Section: Discussionmentioning

confidence: 99%

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

et al. 2015

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“…pulmonary dysfunction. There may be a small reduction in CLD with HFOV use, but the evidence is weakened by overall borderline significance (3). Most studies involving HFOV as ventilator mode focus on its effect on the level of the respiratory zone.…”

Section: Discussionmentioning

confidence: 99%

A translational cellular model to study the impact of high-frequency oscillatory ventilation on human epithelial cell function

Mowes

Jongh

Cox

et al. 2017

Journal of Applied Physiology

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Traditionally, large-animal models are used to analyze the impact of clinical ventilators on lung cellular function. In our dual-chamber model, we interface high-frequency oscillatory ventilation (HFOV) directly with airway cells to study the effects of HFOV independently and combined with hyperoxia. Therefore, it is possible to study the preclinical impact of interventional factors without the high cost of animal models, thus reducing staff, time, as well as animal sparing.

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“…Meta-analyses of a series of additional trials conducted over the next 20 years showed no evidence of a reduction in mortality at 28 days and only a small reduction in the rate of BPD with the use of HFOV compared to CMV, regardless of whether HFOV was used as a rescue intervention after failed conventional ventilation in near term or term infants (BPD defined as supplemental oxygen at 28-30 days or at discharge home: RR 2.26, 95% CI 0.86-5.90) [23], or electively for the prevention of moderate or severe BPD in preterm infants (RR 0.95, 95% CI 0.88-1.03) [24,25]. HFOV can be a valuable alternative to conventional mechanical ventilation.…”

Section: The 1990s: Further Steps In the Right Directionmentioning

confidence: 99%

The Journey Towards Lung Protective Respiratory Support in Preterm Neonates

Berger

Fontana

Stocker³

2013

Neonatology

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The aim of this conceptual review is to provide the reader with a broad perspective on progress made in respiratory support of preterm infants over the past five decades. Landmark discoveries are described in their historical context and underlying theories of lung protection are discussed. The review finishes by integrating different approaches and perspectives into a state-of-the-art concept for lung-protective ventilation in this fragile patient population. Improvements in neonatal respiratory support in the 1970s and 1980s have contributed to dramatic improvements of mortality and morbidity rates among neonates with respiratory failure. Continuous positive airway pressure, antenatal corticosteroids and surfactant replacement therapy revolutionized the care of preterm infants. With the recognition that atelectrauma, volutrauma and oxygen toxicity are the main factors contributing to ventilator-induced lung injury, lung-protective strategies, including noninvasive respiratory support, tidal volume targeting during conventional mechanical ventilation and high frequency ventilation were developed in the 1990s. Given the fact that progress made in the last decade has only resulted in minor improvements in mortality and morbidity rates of neonates with respiratory failure, it seems unlikely that further refinements of current technologies will produce giant leaps forward in high-resource countries. It appears that entirely new approaches would be required. In contrast, knowledge and technology transfer of basic respiratory support strategies (e.g. use of oxygen, simple systems to provide continuous positive airway pressure), could have an enormous impact on the prognosis of neonates with respiratory failure in low-resource countries.

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Elective High-Frequency Oscillatory Ventilation versus Conventional Ventilation for Acute Pulmonary Dysfunction in Preterm Infants

Cited by 16 publications

References 1 publication

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

A translational cellular model to study the impact of high-frequency oscillatory ventilation on human epithelial cell function

The Journey Towards Lung Protective Respiratory Support in Preterm Neonates

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