Prospective Randomized Multicenter Comparison of High-Frequency Oscillatory Ventilation and Conventional Ventilation in Preterm Infants of Less Than 30 Weeks With Respiratory Distress Syndrome

Moriette, G; Paris-Llado, J; Walti, Hervé; Escande, B; Jf, Magny; Cambonie, Gilles; Thiriez, Gérard; Cantagrel, S.; Lacaze‐Masmonteil, Thierry; Storme, Laurent; Blanc, Thierry; Liet, Jean-Michel; André, Ch.; Salanave, Benoît; Breart, Gérard

doi:10.1542/peds.107.2.363

Cited by 158 publications

(97 citation statements)

References 32 publications

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“…Two recent studies, published in the same journal and using similar methodologies, found differing results. 36 Courtney et al 37 compared HFOV with SIMV in infants of 600 to 1200 g birthweight and found a small reduction in the incidence of CLD. However, it is plausible that this difference might be more attributable to the use of SIMV in the control group, and that if A/C had been used, it might have even disappeared.…”

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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“…Finally, three trials compared elective use of HFV in RDS. One study 16 reported a decrease in BPD, and a second study 15 reported a nonsignificant increase in IVH among infants treated with HFOV. A third trial showed no difference in pulmonary or central nervous system outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Two of these studies 9,10 reported lower BPD incidence among infants randomized to high-frequency ventilation (HFV) when compared to IMV, while Wiswell et al 11 had to stop their study because of increase in IVH or PVL among infants randomized to HFJV. Among the eight HFV trials [12][13][14][15][16][17][18][19] published between 1998 and 2003, when surfactant therapy and SIMV were commonly used, only two studies reported a decrease in BPD 13 with HFOV use, and two studies 14,18 reported an increase in air leaks with HIFI use. Finally, three trials compared elective use of HFV in RDS.…”

Section: Introductionmentioning

confidence: 99%

Lung protective ventilatory strategies in very low birth weight infants

Ramanathan

Sardesai

2008

J Perinatol

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Respiratory distress syndrome (RDS) is the most common respiratory diagnosis in preterm infants. Surfactant therapy and mechanical ventilation using conventional or high-frequency ventilation have been the standard of care in the management of RDS. Bronchopulmonary dysplasia (BPD) continues to remain as a major morbidity in very low birth weight infants despite these treatments. There is no significant difference in pulmonary outcome when an optimal lung volume strategy is used with conventional or high-frequency ventilation. Lung injury is directly related to the duration of invasive ventilation via the endotracheal tube. Studies using noninvasive ventilation, such as nasal continuous positive airway pressure and noninvasive positive pressure ventilation, have shown to decrease postextubation failures as well as a trend toward reduced risk of BPD. Lung protective ventilatory strategy may involve noninvasive ventilation as a primary therapy or following surfactant administration in very preterm infants with RDS. Initial steps in the management of preterm infants may also include sustained inflation to establish functional residual capacity, followed by noninvasive ventilation to minimize lung injury and subsequent development of BPD.

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Prospective Randomized Multicenter Comparison of High-Frequency Oscillatory Ventilation and Conventional Ventilation in Preterm Infants of Less Than 30 Weeks With Respiratory Distress Syndrome

Abstract: Early use of high-frequency oscillatory ventilation in very premature infants decreases exogenous surfactant requirements, does not improve the pulmonary outcome, and may be associated with an increased incidence of severe intraventricular hemorrhage.

Cited by 158 publications

References 32 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

Lung protective ventilatory strategies in very low birth weight infants

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