Using very high frequencies with very low lung volumes during high-frequency oscillatory ventilation to protect the immature lung. A pilot study

• Published in: Journal of perinatology Vol. 36; no. 4; pp. 306 - 310
• Main Authors: González-Pacheco, N, Sánchez-Luna, M, Ramos-Navarro, C, Navarro-Patiño, N, de la Blanca, A R-S
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-04-2016; Nature Publishing Group
• Subjects: 692/308/409; 692/700/459; Blood Gas Analysis; Bronchopulmonary Dysplasia - prevention & control; Carbon dioxide; Carbon Dioxide - blood; Care and treatment; Damage prevention; Female; High-Frequency Ventilation - adverse effects; High-Frequency Ventilation - methods; Humans; Infant, Low Birth Weight; Infant, Newborn; Infants; Infants (Premature); Lung diseases; Lung Volume Measurements; Lungs; Male; Mechanical ventilation; Medicine; Medicine & Public Health; Newborn babies; original-article; Pediatric Surgery; Pediatrics; Pilot Projects; Prospective Studies; Respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - blood; Respiratory Distress Syndrome, Newborn - therapy; Tidal Volume - physiology; Ventilation; Very high frequencies; United States
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2015.197

Objective:
High-frequency oscillatory ventilation (HFOV) has been described as a rescue therapy in severe respiratory distress syndrome (RDS) with a potential protective effect in immature lungs. In recent times, HFOV combined with the use of volume guarantee (VG) strategy has demonstrated an independent effect of the frequency on tidal volume to increase carbon-dioxide (CO
2
) elimination. The aim of this study was to demonstrate the feasibility of using the lowest tidal volume on HFOV+VG to prevent lung damage, maintaining a constant CO
2
elimination by increasing the frequency.
Study Design:
Newborn infants with RDS on HFOV were prospectively included. After adequate and stable ventilation using a standard HFOV strategy, the tidal volume was fixed using VG and decreased while the frequency was increased to the highest possible to maintain a constant CO
2
elimination. Pre- and post-PCO
2
, delta pressure and tidal volume obtained in each situation were compared.
Result:
Twenty-three newborn infants were included. It was possible to increase the frequency while decreasing the tidal volume in all patients, maintaining a similar CO
2
elimination, with a tendency to a lower mean PCO
2
after reaching the highest frequency. High-frequency tidal volume was significantly lower, 2.20 ml kg
−1
before vs 1.59 ml kg
−1
at the highest frequency.
Conclusion:
It is possible to use lower delivered tidal volumes during HFOV combined with VG and higher frequencies with adequate ventilation to allow minimizing lung injury.