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

Objective: In a randomized, controlled, multicenter trial, we tested the hypothesis that high-frequency ventilation (HFV) with a high lung volume strategy results in fewer treatment failures than intermittent positive pressure ventilation (IPPV) with high rates and low peak inspiratory pressures. St...

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Bibliographic Details
Published in:	The Journal of pediatrics Vol. 135; no. 1; pp. 39 - 46
Main Authors:	Thome, Ulrich, Kössel, Hans, Lipowsky, Gert, Porz, Friedrich, Fürste, Hans-Otto, Genzel-Boroviczeny, Orsolya, Tröger, Jochen, Oppermann, Hans-Conrad, Högel, Josef, Pohlandt, Frank
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-07-1999 Elsevier
Subjects:	Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Bronchopulmonary Dysplasia - prevention & control Emergency and intensive care: neonates and children. Prematurity. Sudden death Female Germany - epidemiology High-Frequency Ventilation Humans Infant, Newborn Infant, Premature, Diseases - therapy Intensive care medicine Intermittent Positive-Pressure Ventilation Male Medical sciences Regression Analysis Respiratory Insufficiency - mortality Respiratory Insufficiency - therapy Respiratory Mechanics Survival Rate Europe Germany PEEP FIO2 PIP BPD Paw HFV CLD bpm ICH IPPV Human Premature Lung disease Intracranial Nervous system diseases Respiratory disease Treatment efficiency Cardiovascular disease Respiratory intensive care Hemorrhage Incidence Vascular disease Newborn diseases Newborn Positive pressure Intermittent Bronchus disease Bronchopulmonary dysplasia Respiratory distress Ventilation High frequency ventilation Cerebrovascular disease Comparative study
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Summary:	Objective: In a randomized, controlled, multicenter trial, we tested the hypothesis that high-frequency ventilation (HFV) with a high lung volume strategy results in fewer treatment failures than intermittent positive pressure ventilation (IPPV) with high rates and low peak inspiratory pressures. Study design: Infants with a gestational age between ≥24 weeks and <30 weeks, requiring mechanical ventilation within 6 hours of birth, were randomly assigned to receive either IPPV or HFV until 240 hours after randomization, extubation, or meeting treatment failure criteria. Treatment failure, the primary end point, was determined when air leaks, an oxygenation index >35 to 45 (depending on gestational age), death, or chronic lung disease occurred. Chronic lung disease was defined as persistent requirement of mechanical ventilation, continuous positive airway pressure, or supplemental oxygen at a postmenstrual age of 36 weeks. Secondary end points included the incidence of intracranial hemorrhage. Results: The third scheduled interim analysis led to termination of the trial after recruitment of 284 infants. Treatment failure criteria were met by 46% of infants receiving IPPV and 54% of infants receiving HFV (1-tailed primary hypothesis, P = .92; 2-tailed χ2 test, P = .15). Air leaks occurred in 31% and 42% (P = .042), CLD in 23% and 25%, and grade 3-4 intracranial hemorrhage in 13% and 14% of IPPV-treated and HFV-treated patients, respectively. The mortality rate before discharge was 10% in both groups. Conclusion: HFV with a high lung volume strategy did not cause less lung injury in preterm infants than IPPV with a high rate and low peak inspiratory pressures. (J Pediatr 1999;135:39-46)
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0022-3476 1097-6833
DOI:	10.1016/S0022-3476(99)70325-2