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

• 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
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(99)70325-2

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)