Reduction of Barotrauma in Ventilated Neonates by Increase in Ventilation Frequency - First Results of a Prospective Collaborative and Randomized Trial of Two Different Ventilatory Techniques

Pohlandt, Frank; Bernsau, U; Feilen, K.; Hörnchen, H; Leonhardt, Andreas; Hc, Oppermann; Pringsheim, W; Saule, H; Schröder, Heinz C.; Wolff, Christine

doi:10.1203/00006450-198510000-00055

Cited by 14 publications

(5 citation statements)

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“…They found no differences in mean airway pressure related to ventilatory frequency, but peak airway pressure was lower during ventilation at 60 per minute than at 30 per minute. In a randomized controlled trial, Pohlandt et al (54) found a lower incidence of extra-alveolar air leaks when ventilation was given at a frequency of 60 per minute than when low frequencies were used.…”

Section: High-frequency Positive Pressure Ventilation (Hfppv)mentioning

confidence: 99%

“…In newborn infants, Carlo and coworkers (14) found that peak and mean airway pressures were lower during HFJV than during conventional ventilation, implying a decrease in barotrauma. Long-term HFJV may carry a risk of damage to the airway (54). High-frequency jet ventilation has not attained wide use in neonatal intensive care.…”

Section: High-frequency Jet Ventilation (Hfjv)mentioning

confidence: 99%

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CPAP and Mechanical Ventilation

Sedin

1991

Int J Technol Assess Health Care

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Respiratory insufficiency has previously been a frequent cause of neonatal death, especially in preterm infants. As late as in 1967, Silverman and associates (66) found that in infants with hyaline membrane disease (HMD), mechanical ventilation with a body-enclosing negative pressure respirator did not improve survival. Before 1970, the mortality among infants who required respiratory therapy was high (20;46;70). At the end of the 1960s and the beginning of the 1970s, several new methods were introduced to improve ventilation of newborn infants. Kirby and coworkers (41) introduced intermittent mandatory ventilation as a way of weaning from mechanical ventilation. In a series of studies, Reynolds and coworkers evaluated the effects of different peak airway pressures, respiratory frequencies, and inspiratory:expiratory ratios on arterial blood gases and right to left shunts (32;58;59;60).

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Section: High-frequency Positive Pressure Ventilation (Hfppv)mentioning

confidence: 99%

Section: High-frequency Jet Ventilation (Hfjv)mentioning

confidence: 99%

CPAP and Mechanical Ventilation

Sedin

1991

Int J Technol Assess Health Care

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“…Greenough et al [20] also reported a significant reduction in the incidence of pneumothoraces in a group of babies ventilated at higher frequencies (> 100/min) who had pulmonary interstitial emphysema (PIE) compared to another group ventilated at conventional rates. A recent multi-centre study has provided further information supporting the contention that pneumothoraces are less likely to occur if the respiratory rate is increased to the even modest level of 60/rain [29].…”

Section: Hfppv and Pneumothoracesmentioning

confidence: 91%

High frequency ventilation in the neonatal period

Greenough

Milner

1987

Eur J Pediatr

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There are three forms of high frequency ventilation, high frequency jet ventilation (HFJV, up to 400/min), high frequency oscillation (HFO, up to 40 Hz), and high frequency positive pressure ventilation (HFPPV, rates between 60 and 150/min). The first two forms of ventilation are still experimental and have been used only in critically ill children where respiratory failure has been unresponsive to more conventional therapy. Unfortunately, however, HFJV has already been associated with a high incidence of tracheal lesions. High-frequency positive pressure ventilation, on the other hand, using conventional ventilators, has been used and studied widely. Certain neonatal ventilators function suboptimally at increased rates, resulting in a reduction in tidal exchange with a consequent clinical deterioration. Using appropriate ventilators, arterial oxygen tensions improve and carbon dioxide tensions are reduced at fast rates in non-paralysed infants. Air-trapping, however, may be a problem in infants paralysed and ventilated at fast rates. HFPPV have been associated with a reduced incidence of pneumothoraces, but there is no knowledge of the effect of this form of ventilation on subsequent lung growth.

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“…Normal outcome 69 (79) 69 (77) 1 2 (0-6 to 2 4) Cerebral palsy 4 (5) 12 (13) 0 4 (0-1 to 1 0) Other central nervous system disease 2 (2) 5 (6) 0 4 (0-1 to 1-9) Severe hearing impairment 4 (5) 8 (9) 0 4 (0-1 to 1-3) Severe visual impairment 6 (7) 13 (14) 0-5 (0-2 to 1-2) Global developmental delay 4 (5) 6 (7) 0 7 (0-2 to 2 4) *Percentages total more than 100 because some infants had more than one condition. 'blind'), those allocated to receive HFPPV showed no increase in neurodevelopmental complications or abnormal outcomes (table 4).…”

Section: Specified Analyses Of Outcomementioning

confidence: 99%

Multicentre randomised controlled trial of high against low frequency positive pressure ventilation. Oxford Region Controlled Trial of Artificial Ventilation OCTAVE Study Group.

1991

Archives of Disease in Childhood

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A total of 346 infants aged <72 hours were randomly allocated to be treated either by high frequency positive pressure ventilation (HFPPV; rate fixed at 60/minute throughout treatment and initial inspiratory:expiratory (I:E) ratio 1:2, increased to 1:1 if necessary) or by low frequency positive pressure ventilation (LFPPV; rate 640/minute and initial I:E ratio usually 1:1, both decreasing during weaning). The main hypotheses were that HFPPV reduces pneumothorax, chronic lung disease and death before discharge in all infants, as well as those with hyaline membrane disease, and that it reduces the incidence of later neurodevelopmental complications in infants of <33. weeks' gestation. Among all the infants the rate of pneumothorax was 19% in the HFPPV group and 26% in the LFPPV group (p=0-13; odds ratio 0-7, 95% confidence intervals (CI) 0-4 to 1.1); there was no difference in mortality or the incidence of chronic lung disease. In infants of <33 weeks' gestation there were no differences in adverse neurodevelopmental outcomes. Among the subgroup of 237 infants with hyaline membrane disease, median fractional inspired oxygen at the time of entry to the trial was 0-6 in the HFPPV group and 0-7 in the LFPPV group, indicating that many had moderately severe disease. In patients with hyaline membrane disease HFPPV was associated with a lower rate of pneumothorax (18% in the HFPPV group compared with 33% in the LFPPV group, p=0-013, odds ratio 0*5, 95% CI 0-3 to 0.8), with no differences in mortality, or in duration of intubation or supplementary oxygen in survivors. As used in this study, HFPPV

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Reduction of Barotrauma in Ventilated Neonates by Increase in Ventilation Frequency - First Results of a Prospective Collaborative and Randomized Trial of Two Different Ventilatory Techniques

Cited by 14 publications

References 0 publications

CPAP and Mechanical Ventilation

CPAP and Mechanical Ventilation

High frequency ventilation in the neonatal period

Multicentre randomised controlled trial of high against low frequency positive pressure ventilation. Oxford Region Controlled Trial of Artificial Ventilation OCTAVE Study Group.

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