Randomized comparison of high-frequency ventilation with high-rate intermittent positive pressure ventilation in preterm infants with respiratory failure

The Sy-Fi Study: A Randomized Prospective Trial of Synchronized Intermittent Mandatory Ventilation Versus a High-Frequency Flow Interrupter in Infants Less Than 1000 G

“…Rimensberger et al 18 utilized the high-frequency oscillator as the sole mode of mechanical ventilation and compared this to historical controls. They demonstrated fewer ventilator days, a shorter period of oxygen 9 randomized 284 infants between 24 and 29 weeks' gestation to HFFI utilizing the Infant Star Ventilator or conventional ventilation utilizing multiple ventilators within 6 hours of birth (elective) and continued the strategy until 240 hours after randomization. They found no significant difference in BPD at either 30 days or 36 weeks in the HFFI versus conventional ventilation groups (88% vs 88% at 30 days, 25% vs 23% at 36 weeks).…”

“…13 To date, there has been only one study examining the efficacy of the high-frequency flow interruption (HFFI) as a primary mode of ventilation. 9 Synchronized intermittent mandatory ventilation (SIMV) has become a popular mode of ventilation for many preterm infants. This mode of ventilation has been shown to reduce the incidence of BPD from 72% to 47% in infants less than 1000 g at birth.…”

The clinical impact of high frequency ventilation: review of the cochrane meta-analyses

“…Piston Oscillator, the Infant Star Ventilator 16 and the French Piston Oscillator. 18 The studies of Johnson 20 and Van Reempts 21 used a variety of ventilators in the intervention group.…”

“…Five trials reported on oxygen dependency at 28 to 30 days in surviving infants. 12,[16][17][18]21 Of these five trials, no individual trial reported a decrease in the risk of oxygen dependency at 28 to 30 days. The meta-analysis of these five trials demonstrated no difference in the risk of oxygen dependency at 28 days (typical RR 0.95, 95% CI 0.83, 1.09; typical RD À0.02, 95% CI À0.09, 0.04).…”

Lung protective ventilatory strategies in very low birth weight infants

“…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.…”