The Value of High Frequency Oscillatory Ventilation Combined with Volume Guarantee in Extremely Preterm Infants with Respiratory Distress Syndrome

Abstract

Background Early hypocapnia in extremely preterm infants is associated with intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). The results of foreign studies show that high frequency oscillatory ventilation combined with volume guarantee ventilation (HFOV+VG) has been confirmed to reduce hypocapnia in preterm infants, but less is known of using HFOV+VG in extremely preterm infants born at <28 weeks gestational age. Objective To investigate the clinical efficacy of HFOV+VG in the treatment of respiratory distress syndrome with extremely premature infants. Methods Extremely preterm infants with respiratory distress syndrome admitted to the NICU of Xinxiang Central Hospital (the Fourth Clinical College of Xinxiang Medical College) at a gestational age of <28 weeks and a birth weight of <1 000 g, who required invasive mechanical ventilation, were prospectively selected as the study subjects and were divided into the HFOV+VG group and the synchronized intermittent mandatory ventilation (SIMV) group according to the randomized numeric table method. Arterial blood gas analysis was performed 48h after trial initiation for invasive ventilation duration, total respiratory support duration, case fatality, and incidence of hypocapnia, periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), late onset sepsis (LOS), pneumothorax, ventilator-associated pneumonia (VAP), bronchopulmonary dysplasia (BPD), neonatal necrotizing enterocolitis (NEC), and grade 3-4 periventricular-intraventricular hemorrhage (IVH) . Results In HFOV+VG group, the duration of invasive ventilation and total respiratory support time were shorter than SIMV group, and the incidence of hypocapnia and PVL were lower than SIMV group, and there were all significant statistical differences the two groups (P<0.05), while the incidence of ROP, LOS, pneumothorax, VAP, BPD, NECand grade 3-4 IVH were not significant (P>0.05) . Conclusion Compared with SIMV ventilation, HFOV+VG ventilation in extremely preterm infants born at <28 weeks gestational age has better clinical results and does not increase adverse effects, which deserves clinical promotion.

Keywords

• respiratory distress syndrome|extremely preterm infants|high frequency oscillatory ventilation|volume guarantee|randomized controlled trial