TY - JOUR
T1 - First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis
AU - Salvo, Vincenzo
AU - Zimmermann, Luc J.
AU - Gavilanes, Antonio W.
AU - Barberi, Ignazio
AU - Ricotti, Alberto
AU - Abella, Raul
AU - Frigiola, Alessandro
AU - Giamberti, Alessandro
AU - Florio, Pasquale
AU - Tagliabue, Paolo
AU - Tina, Lucia G.
AU - Nigro, Francesco
AU - Temporini, Francesca
AU - Gazzolo, Diego
PY - 2012/1
Y1 - 2012/1
N2 - Objective: Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are, to date, still matter of debate. We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed. Design: Multicenter randomized control trial. Setting: Three tertiary centers of neonatal intensive care units from December 2004 to December 2007. Population: Eighty-eight very low birth weight infants complicated by respiratory distress syndrome, without antenatal glucocorticoids, supported by first intention high-frequency oscillatory ventilation (n = 44) or conventional mechanical ventilation (n = 44). Interventions: All newborns were monitored by standard monitoring procedure, including routine laboratory variables, neurologic patterns, and ultrasound imaging. Primary outcomes were: the length of ventilatory support, the need of reintubation, and the length of nasal continuous positive airway pressure support in the postextubation period. Secondary outcomes were: the length of stay in neonatal intensive care unit and in hospital, death before discharge, adverse short-and long-term pulmonary and neonatal outcomes, and the need for a second dose of surfactant and of postnatal glucocorticoid treatment. Results: High-frequency oscillatory ventilation infants showed a significant lower duration (p <.001 for all) of ventilator dependency, lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period. Among secondary outcomes in the high-frequency oscillatory ventilation infants, the need of a second dose of surfactant administration, and the length of stay in the neonatal intensive care unit and in hospital were significantly lower (p <.05 for all). Conclusions: We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support, surfactant therapy, and reintubation, and shortened neonatal intensive care unit and hospital stay, thus reducing unit and hospital costs. These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population, such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids. (Pediatr Crit Care Med 2012; 13:72-79)
AB - Objective: Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are, to date, still matter of debate. We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed. Design: Multicenter randomized control trial. Setting: Three tertiary centers of neonatal intensive care units from December 2004 to December 2007. Population: Eighty-eight very low birth weight infants complicated by respiratory distress syndrome, without antenatal glucocorticoids, supported by first intention high-frequency oscillatory ventilation (n = 44) or conventional mechanical ventilation (n = 44). Interventions: All newborns were monitored by standard monitoring procedure, including routine laboratory variables, neurologic patterns, and ultrasound imaging. Primary outcomes were: the length of ventilatory support, the need of reintubation, and the length of nasal continuous positive airway pressure support in the postextubation period. Secondary outcomes were: the length of stay in neonatal intensive care unit and in hospital, death before discharge, adverse short-and long-term pulmonary and neonatal outcomes, and the need for a second dose of surfactant and of postnatal glucocorticoid treatment. Results: High-frequency oscillatory ventilation infants showed a significant lower duration (p <.001 for all) of ventilator dependency, lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period. Among secondary outcomes in the high-frequency oscillatory ventilation infants, the need of a second dose of surfactant administration, and the length of stay in the neonatal intensive care unit and in hospital were significantly lower (p <.05 for all). Conclusions: We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support, surfactant therapy, and reintubation, and shortened neonatal intensive care unit and hospital stay, thus reducing unit and hospital costs. These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population, such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids. (Pediatr Crit Care Med 2012; 13:72-79)
KW - bronchopulmonary dysplasia
KW - conventional mechanical ventilation
KW - glucocorticoids
KW - high-frequency oscillatory ventilation
KW - respiratory distress syndrome
KW - surfactant
KW - very low birth weight
U2 - 10.1097/PCC.0b013e318219673e
DO - 10.1097/PCC.0b013e318219673e
M3 - Article
C2 - 21499177
SN - 1529-7535
VL - 13
SP - 72
EP - 79
JO - Pediatric critical care medicine
JF - Pediatric critical care medicine
IS - 1
ER -