Prospective Randomized Multicenter Comparison of High-Frequency Oscillatory Ventilation and Conventional Ventilation in Preterm Infants of Less Than 30 Weeks With Respiratory Distress Syndrome
| Autor: | Benoît Escande, Thierry Lacaze-Masmonteil, Laurent Storme, Jean François Magny, Thierry Blanc, Josefa Paris-Llado, Gérard Bréart, Jean Michel Liet, Benoit Salanave, Gilles Cambonie, H Walti, Gérard Thiriez, G. Moriette, Christine André, Sylvain Cantagrel |
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| Rok vydání: | 2001 |
| Předmět: |
Male
Artificial ventilation Birth weight medicine.medical_treatment High-Frequency Ventilation medicine Humans Lung volumes Prospective Studies Bronchopulmonary Dysplasia Cerebral Hemorrhage Respiratory Distress Syndrome Newborn Respiratory distress business.industry Incidence High-frequency ventilation Infant Newborn Oxygen Inhalation Therapy Postmenstrual Age Pulmonary Surfactants medicine.disease Respiration Artificial Treatment Outcome Intraventricular hemorrhage Anesthesia Pediatrics Perinatology and Child Health Breathing Female business Infant Premature |
| Zdroj: | Pediatrics. 107:363-372 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.107.2.363 |
| Popis: | Background.Early use of high-frequency ventilation and exogenous surfactant is proposed as the optimal mode of ventilatory support in infants with respiratory distress syndrome. In very premature infants, we tested the hypothesis that high-frequency versus conventional ventilation could decrease exogenous surfactant requirements and improve pulmonary outcome, without altering the complication rate, including that of severe intraventricular hemorrhage.Methods.Preterm infants with a postmenstrual age of 24 to 29 weeks, presenting with respiratory distress syndrome were randomly assigned to high-frequency oscillatory ventilation (lung volume recruitment strategy) or conventional ventilation.Results.Two hundred seventy-three infants were enrolled. One hundred fifty-three had a postmenstrual age of 24 to 27 weeks, and 143 had a birth weight ≤1000 g. One hundred thirty-four infants were randomized at 142 minutes of life (median) to receive conventional ventilation (mean postmenstrual age at birth: 27. 6 ± 1.5 weeks; mean birth weight: 997 ± 245 g); and 139 infants were randomized at 145 minutes of life to receive high-frequency ventilation (mean postmenstrual age at birth: 27.5 ± 1.4 weeks; mean birth weight: 976 ± 219 g).High-frequency ventilation, compared with conventional ventilation, was associated with a twofold reduction in the requirement for ≥2 instillations of exogenous surfactant (30% vs 62%; odds ratio: .27; 95% confidence interval: .16–.44) and no difference in pulmonary outcome. The incidence of severe intraventricular hemorrhage was 24% in the high-frequency group and 14% in the conventional ventilation group (adjusted odds ratio: 1.50; 95% confidence interval: .68–3.30).Conclusion.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. |
| Databáze: | OpenAIRE |
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