High-frequency ventilation and conventional mechanical ventilation in newborn babies with respiratory distress syndrome: A prospective, randomized trial Randomized controlled trial of volume-targeted synchronized ventilation and conventional intermittent mandatory ventilation following initial exogenous surfactant therapy. First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis* Mechanical ventilation of very low birth weight infants: is volume or pressure a better target variable? Randomized trial of high-frequency jet ventilation versus conventional ventilation in respiratory distress syndrome. High-frequency jet ventilation in the early management of respiratory distress syndrome is associated with a greater risk for adverse outcomes. [Randomized controlled study of targeted tidal volume ventilation for treatment of severe neonatal respiratory distress syndrome]. Is there an Advantage of Using Pressure Support Ventilation with Volume Guarantee in the Initial Management of Premature Infants with Respiratory Distress Syndrome? A pilot study Impact of volume guarantee on synchronized ventilation in preterm infants: a randomized controlled trial Nasal CPAP or intubation at birth for very preterm infants. Early neonatal outcomes of volume guaranteed ventilation in preterm infants with respiratory distress syndrome Randomised trial of volume controlled versus time cycled, pressure limited ventilation in preterm infants with respiratory distress syndrome Lung recruitment maneuver during volume guarantee ventilation of preterm infants with acute respiratory distress syndrome. Volume guarantee versus high-frequency ventilation: lung inflammation in preterm infants Effects of pressure support ventilation plus volume guarantee vs. high-frequency oscillatory ventilation on lung inflammation in preterm infants. The Provo multicenter early high-frequency oscillatory ventilation trial: improved pulmonary and clinical outcome in respiratory distress syndrome. International randomised controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome High-Frequency Oscillatory Ventilation Versus Synchronized Intermittent Mandatory Ventilation Plus Pressure Support in Preterm Infants With Severe Respiratory Distress Syndrome Randomised controlled trial of patient triggered and conventional fast rate ventilation in neonatal respiratory distress syndrome Randomized study of high-frequency oscillatory ventilation in infants with severe respiratory distress syndrome. HiFO Study Group.
Objective Morbidity and mortality remain high amongst babies ventilated for a respiratory distress syndrome ( RDS ) . Whether newly developed ventilators allowing high frequency ventilation such as high frequency flow interrupted ventilation ( HFFIV ) could decrease the morbidity and the mortality was investigated in a r and omized study . Design Preterm babies weighing ≤1800 g suffering from RDS and ventilated by conventional mechanical ventilation ( CMV )  were r and omized to be further ventilated either by CMV ( group CMV ) or by HFFIV ( group HFFIV ) when peak inspiratory pressure ( PIP ) on CMV was ≥20cmH2O . Setting The study was undertaken in the neonatal intensive care unit of the Erasmus Hospital . Patients 24 patients entered into the investigation and were r and omized but 2 patients were removed from the study because the switch over to HFFIV failed . Eight of the 12 CMV  patients and 5 of the 10 HFFIV  patients completed the study . Measurements and results Clinical variables , blood gas analysis and ventilatory variables were looked at . There were no differences in mortality , in incidence of air leaks and pulmonary complications or in blood gas analysis . Bronchopulmonary dysplasia was not decreased by the use of HFFIV . Conclusion It is concluded that HFFIV  is safe although it offers no concrete advantages over CMV when applied as we did in a low pressure approach We set out to evaluate the impact of volume-targeted synchronized ventilation and conventional intermittent m and atory ventilation ( IMV ) on the early physiologic response to surfactant replacement therapy in neonates with respiratory distress syndrome ( RDS ) . We hypothesized that volume-targeted , patient-triggered synchronized ventilation would stabilize minute ventilation at a lower respiratory rate than that seen during volume-targeted IMV , and that synchronization would improve oxygenation and decrease variation in measured tidal volume ( V(t ) ) . This was a prospect i ve , r and omized study of 30 hospitalized neonates with RDS . Infants were r and omly assigned to volume-targeted ventilation using IMV ( n = 10 ) , synchronized IMV ( SIMV ; n = 10 ) , or assist/control ventilation ( A/C ; n = 10 ) after meeting eligibility requirements and before initial surfactant treatment . Following measurements of arterial blood gases and cardiovascular and respiratory parameters , infants received surfactant . Infants were studied for 6 hr following surfactant treatment . Infants assigned to each mode of ventilation had similar birth weight , gestational age , and Apgar scores at birth , and similar oxygenation indices at r and omization . Three patients were eliminated from final data analysis because of exclusionary conditions unknown at r and omization . Oxygenation improved significantly following surfactant therapy in all groups by 1 hr after surfactant treatment ( P < 0.05 ) . No further improvements occurred with time . Total respiratory rate was lowest ( P < 0.05 ) and variation in tidal volume ( V(t ) ) was least in the A/C group ( P < 0 . 05 ) . Minute ventilation ( V(')(E ) ) , delivered airway pressures , respiratory system mechanics , and hemodynamic parameters were similar in all groups . We conclude that volume-targeted A/C ventilation result ed in more consistent tidal volumes at lower total respiratory rates than IMV or SIMV .  Oxygenation and lung mechanics were not altered by synchronization , possibly due to the volume-targeting strategy . Of the modes studied , A/C , a fully-synchronized mode , may be the most efficient method of mechanical ventilator support in neonates receiving surfactant  for treatment of RDS Objective : Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are , to date , still matter of debate . We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed . Design : Multicenter r and omized control trial . Setting : Three tertiary centers of neonatal intensive care units from December 2004 to December 2007 . Population : Eighty-eight very low birth weight infants complicated by respiratory distress syndrome , without antenatal glucocorticoids , supported by first intention high-frequency oscillatory ventilation ( n = 44 ) or conventional mechanical ventilation ( n = 44 ) . Interventions : All newborns were monitored by st and ard monitoring procedure , including routine laboratory variables , neurologic patterns , and ultrasound imaging . Primary outcomes were : the length of ventilatory support , the need of reintubation , and the length of nasal continuous positive airway pressure support in the postextubation period . Secondary outcomes were : the length of stay in neonatal intensive care unit and in hospital , death before discharge , adverse short- and long-term pulmonary and neonatal outcomes , and the need for a second dose of surfactant and of postnatal glucocorticoid treatment .  Results : High-frequency oscillatory ventilation infants showed a significant lower duration ( p < .001 for all ) of ventilator dependency , lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period . Among secondary outcomes in the high-frequency oscillatory ventilation infants , the need of a second dose of surfactant administration , and the length of stay in the neonatal intensive care unit and in hospital were significantly lower ( p < .05 for all ) . Conclusions : We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support , surfactant therapy , and reintubation , and shortened neonatal intensive care unit and hospital stay , thus reducing unit and hospital costs . These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population , such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids OBJECTIVE To compare the efficacy and safety of volume-controlled ( VC ) ventilation to time-cycled pressure-limited ( TCPL ) ventilation in very low birth weight infants with respiratory distress syndrome ( RDS ) . STUDY DESIGN Newborns weighing between 600 and 1500 g and with a gestational age of 24 to 31 weeks who had RDS were r and omized to receive either VC or TCPL ventilation and treated with a st and ardized protocol . The 2 modalities were compared by determining the time required to achieve a predetermined success criterion , on the basis of either the alveolar-arterial oxygen gradient < 100 mm Hg or the mean airway pressure < 8 cm H(2)O. Secondary outcomes included mortality , duration of mechanical ventilation , and complications commonly associated with ventilation . RESULTS The mean time to reach the success criterion was 23 hours in the VC group versus 33 hours in the TCPL group ( P = .15 ) . This difference was more striking in babies weighing < 1000 g ( 21 versus 58 hours ; P = .03 ) . Mean duration of ventilation with VC  was 255 hours versus 327 hours with TCPL ( P = .60 ) . There were 5 deaths in the VC group and 10 deaths in the TCPL group ( P = .10 ) . The incidence of other complications was similar . CONCLUSION VC ventilation is safe and efficacious in very low birth weight infants and may have advantages when compared with TCPL , especially in smaller infants To compare high-frequency jet ventilation ( HFJV ) with pressure-limited time-cycled conventional ventilation ( CV ) , we r and omized 41 infants with clinical and radiographic evidence of respiratory distress syndrome during the first day of life to receive either HFJV or CV .  St and ardized ventilatory protocol s were used for 48 hours , after which CV was administered to both groups . Despite comparable oxygenation ( arterial/alveolar oxygen tension ratio ) , mean airway pressure was lower in the HFJV group ( 9 + /- 2 vs 13 + /- 2 cm H2O , P less than 0.001 ) , and thus the arterial/alveolar oxygen tension ratio corrected for mean airway pressure was improved in the HFJV group ( P less than 0.05 ) . PaCO2 was lower during HFJV ( 37 + /- 3 vs 42 + /- 3 mm Hg , P less than 0.05 ) despite a comparable peak inspiratory pressure . The incidence of air leaks , progression of intraventricular hemorrhage , and mortality during the 48-hour period did not differ between the two groups . Bronchoscopies in eight infants given HFJV and five given CV revealed no microscopic evidence of necrotizing tracheobronchitis , but one infant given HFJV had evidence of necrotizing tracheitis at autopsy . We conclude that for 48 hours during the acute stage of respiratory distress syndrome , HFJV can maintain adequate gas exchange at lower mean airway pressure than during CV , without an increase in the incidence of side effects OBJECTIVE The objective of this investigation was to determine if high-frequency jet ventilation ( HFJV ) used early in the treatment of premature infants with respiratory distress syndrome was effective in reducing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes . STUDY DESIGN A total of 73 premature infants who met the inclusion criteria ( gestational age of less than 33 weeks , birth weight of more than 500 g , age of less than 24 hours , need for assisted ventilation with peak inspiratory pressure of more than 16 and FIO2 more than 0.30 , and roentgenographic evidence of respiratory distress syndrome ) were r and omized to either conventional ( n = 36 ) or to high-frequency jet  ( n = 37 ) ventilation . Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they could either be extubated or meet crossover criteria . Univariate analyses were initially used to compare the two groups . Stepwise logistic regression was subsequently used to assess whether various factors independently influenced adverse outcomes . RESULTS The two groups of infants were similar in all obstetrical , perinatal , and neonatal demographic characteristics . The mean birth weight and gestational age in the conventional group were 930 g and 26.6 weeks and in the HFJV group , 961 g and 26.9 weeks . The infants were r and omized at similar ages ( 7.1 and 7.3 hours of life , respectively ) . Their prer and omization ventilator setting s and arterial blood gases were nearly identical . There were no differences in pulmonary outcomes ( occurrence of air leaks , need for oxygen or ventilation at 36 weeks postconception ) , and there were no differences in the mean number of days oxygen was required , number of days ventilated , or length of hospital stay . Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leukomalacia ( 10 vs 2 , P = .022 ) or to have a poor outcome ( grade IV hemorrhage , cystic periventricular leukomalacia , or death ) ( 17 vs 7 , P = .016 ) . Logistic regression analysis revealed HFJV to be a significant independent predictor of both cystic periventricular leukomalacia and a poor outcome . The presence of hypocarbia was not an independently significant predictor of adverse outcomes . CONCLUSIONS With the HFJV treatment strategy that we used , use of the high-frequency jet ventilator in the early management of premature infants with respiratory distress syndrome result ed in significantly more adverse outcomes than in those treated with conventional mechanical ventilation OBJECTIVE To evaluate the efficacy of targeted tidal volume ventilation in the treatment of severe neonatal respiratory distress syndrome ( RDS ) . METHODS Eighty-four neonates with severe RDS between June 2008 and January 2010 were r and omly assigned to 3 groups according to the ventilation mode : synchronized intermittent positive pressure ventilation plus volume guarantee ( SIPPV+VG ; n=31 ) , high frequency oscillation ventilation ( HFOV ; n=23 ) and intermittent m and atory ventilation ( IMV ; n=30 ) . The oxygenation status , the duration s of oxygen exposure and ventilation and the incidence of complications were observed . RESULTS The oxygenation status ( P/F and a/APO2 ) in the SIPPV+VG and the HFOV groups was improved significantly 12 hrs after ventilation ( P<0.05 ) . While in the IMV group , the oxygenation status was not improved until 24 hrs after ventilation . The duration s of oxygen exposure and ventilation in the SIPPV+VG and the HFOV groups were shorter than in the IMV group ( P<0.05 ) . The incidences of air leak syndrome and ventilation-associated pneumonia ( VAP ) were lower in the SIPPV+VG and the HFOV groups than in the IMV group ( P<0.05 ) . The incidence of severe intracranial hemorrhage in the HFOV group was higher than in the other two groups ( P<0.05 ) . CONCLUSIONS Compared with IMV , SIPPV+VG and HFOV can improve the oxygenation status more quickly , shorten the ventilation duration and decrease the incidences of air leak syndrome and VAP in neonates with severe RDS OBJECTIVE : To evaluate the feasibility of using the pressure support ventilation with volume guarantee ( PSV-VG ) as an initial ventilatory mode in preterm infants with respiratory distress syndrome ( RDS ) after surfactant treatment to achieve accelerated weaning of peak inspiratory pressure ( PIP ) and mean airway pressure ( MAP ) . STUDY DESIGN : Initial 24-hour ventilatory parameters were compared in two groups of preterm infants managed by PSV-VG and the synchronized intermittent m and atory ventilation ( SIMV ) mode in a r and omized controlled pilot study after surfactant treatment for RDS . A total of 16 babies were r and omized to PSV-VG ( 1198±108 g [ mean±SEM ] ; 27.9±0.6 weeks ) and 18 babies to SIMV ( birth weight 1055±77 g ; gestational age 27.4±0.5 weeks ) . Repeated measures analysis of variance was used to compare serial values of PIP and MAP in the two groups . RESULTS : The PIP and MAP decreased over time ( p<0.001 ) during the first 24 hours after surfactant administration in both groups but the decrease in MAP was faster in the SIMV group compared to PSV-VG group ( p=0.035 ) . The median numbers of blood gases during the first 24 hours were four and two in the SIMV and PSV-VG groups , respectively ( p<0.001 ) . The overall outcomes were not significantly different between the two groups . CONCLUSION : PSV-VG did not offer any ventilatory advantage  over SIMV in the initial management of surfactant-treated premature newborns with RDS except for minimizing the number of blood gases Purpose The aim of this r and omized controlled trial was to assess whether the addition of volume guarantee ( VG ) to triggered ventilation decreases the duration of ventilation in very low birth weight ( VLBW ) infants with respiratory distress syndrome ( RDS ) . Methods Infants were r and omized into two groups to initially receive either assist/control ( A/C ) or A/C plus VG ventilation and then weaned with synchronized intermittent m and atory ventilation ( SIMV ) or SIMV plus VG . Results Forty-five infants were included in the study . The demographic and clinical characteristics , values of tidal volume ( VT ) , peak inspiratory pressure ( PIP ) , fraction of inspired oxygen , carbon dioxide tension , and pH were similar for all participating infants initially . During the follow-up , the VT levels were more stable , and the PIP levels were significantly decreasing in the VG group . Although the duration of ventilation was shorter in the VG group , this trend was not statistically significant . The incidences of death and bronchopulmonary dysplasia ( BPD ) were not significantly different , but the combined outcome of death or BPD was lower in the VG group . Although the VG group experienced less frequent BPD , periventricular leukomalacia , and intraventricular hemorrhage , these differences were not statistically different . Conclusion The VG option , when combined with A/C ( in the acute phase of RDS ) and SIMV ( in the weaning ) , reduced VT variability , and may have shortened the duration of ventilation in VLBW infants .  Overall mortality and BPD rates did not change , but their combined outcome was significantly improved in infants treated with VG modes as compared to those treated with synchronized pressure-limited modes alone BACKGROUND Bronchopulmonary dysplasia is associated with ventilation and oxygen treatment . This r and omized trial investigated whether nasal continuous positive airway pressure ( CPAP ) , rather than intubation and ventilation , shortly after birth would reduce the rate of death or bronchopulmonary dysplasia in very preterm infants . METHODS We r and omly assigned 610 infants who were born at 25-to-28-weeks ' gestation to CPAP or intubation and ventilation at 5 minutes after birth . We assessed outcomes at 28 days of age , at 36 weeks ' gestational age , and before discharge . RESULTS At 36 weeks ' gestational age , 33.9 % of 307 infants who were assigned to receive CPAP had died or had bronchopulmonary dysplasia , as compared with 38.9 % of 303 infants who were assigned to receive intubation ( odds ratio favoring CPAP , 0.80 ; 95 % confidence interval [ CI ] , 0.58 to 1.12 ; P=0.19 ) . At 28 days , there was a lower risk of death or need for oxygen therapy in the CPAP group than in the intubation group ( odds ratio , 0.63 ; 95 % CI , 0.46 to 0.88 ; P=0.006 ) . There was little difference in overall mortality . In the CPAP group , 46 % of infants were intubated during the first 5 days , and the use of surfactant was halved . The incidence of pneumothorax was 9 % in the CPAP group , as compared with 3 % in the intubation group ( P<0.001 ) . There were no other serious adverse events . The CPAP group had fewer days of ventilation . CONCLUSIONS In infants born at 25-to-28-weeks ' gestation , early nasal CPAP did not significantly reduce the rate of death or bronchopulmonary dysplasia , as compared with intubation . Even though the CPAP group had more incidences of pneumothorax , fewer infants received oxygen at 28 days , and they had fewer days of ventilation . ( Australian New Zeal and Clinical Trials Registry number , 12606000258550 . ) Background : Volume guaranteed ( VG ) synchronized intermittent m and atory ventilation ( SIMV ) is a novel mode of SIMV that provides automatic adjustment of the peak inspiratory pressure for ensuring a minimum set tidal volume and there are limited data about the effects of VG ventilation on short term neonatal outcomes in preterm infants with respiratory distress syndrome ( RDS ) . Objective : The main objective of this study was to evaluate the effect of VG ventilation on duration of ventilation and total supplemental oxygen . We also aim ed to compare the early neonatal outcomes of VG ventilation versus conventional SIMV on short-term outcomes in preterm babies with RDS who were given surfactant . Methods : In this r and omized controlled study , preterm infants who were admitted with RDS and given surfactant were divided into 2 groups : group 1 included infants ventilated on conventional SIMV ( n = 30 ) and group 2 included infants ventilated on VG ventilation ( n = 42 ) . Neonatal morbidities such as air leak , bronchopulmonary dysplasia ( BPD ) , intraventricular hemorrhage ( IVH ) , retinopathy of prematurity ( ROP ) , necrotizing enterocolitis ( NEC ) and duration of mechanical ventilation and total oxygen supplementation were all recorded . Results : There were no significant differences between two groups in terms of demographic features . Infants ventilated with VG mode had significantly shorter duration of ventilation and need of total supplemental oxygen . The incidences of oxygen related short term complications including BPD , ROP , and IVH were also significantly lower in these infants compared with those ventilated with conventional SIMV . No significant differences were found between two groups with respect to NEC and air leak . Conclusion : In conclusion , VG ventilation in combination with surfactant treatment significantly reduced both duration of mechanical ventilation and early neonatal oxygen related morbidities including BPD , ROP and IVH in preterm infants with RDS . This data favors the use of VG ventilation in respiratory support of premature infants Fifty preterm infants weighing 1200 g or more with clinical and radiographic evidence of respiratory distress syndrome , requiring both mechanical ventilation and exogenous surfactant replacement , were r and omly allocated to receive either volume controlled ventilation or time cycled , pressure limited ventilation . Tidal volume delivery in each group was deliberately controlled at 5–8 ml/kg so that the only difference between the two groups was the ventilatory modality , the manner in which tidal volume was delivered . The rest of the ventilatory management and clinical care was done according to protocol . The two modes of ventilation were compared by determining the time required to achieve pre-determined success criteria , based on either the alveolar – arterial oxygen gradient or the mean airway pressure as a st and ard against which the speed of weaning could be objective ly assessed . Infants r and omised to volume controlled ventilation met success criteria sooner and had a shorter duration of mechanical ventilation . These babies also had a significantly lower incidence of intraventricular haemorrhages and abnormal periventricular echodensities on ultrasound scans . Volume controlled ventilation  seems to be both safe and effective in this group of patients Preterm infants need the achievement of adequate lung volume . Lung recruitment maneuver ( LRM ) is applied during high-frequency oscillatory ventilation . We investigated the effect of an LRM with positive end-expiratory pressure ( PEEP ) on oxygenation and outcomes in infants conventionally ventilated for respiratory distress syndrome ( RDS ) . Preterm infants in assisted controlled ventilation+volume guarantee for RDS after surfactant r and omly received an LRM ( group A ) or did not ( group B ) . LRM entailed increments of 0.2 cm H (2)O PEEP every 5 minutes , until fraction of inspired oxygen ( Fi O(2))=0.25 . Then PEEP was reduced and the lung volume was set on the deflation limb of the pressure/volume curve . When saturation of peripheral oxygen fell and Fi O(2 ) rose , we reincremented PEEP until Sp O(2 ) became stable . Group A ( N=10 ) and group B ( N=10 ) infants were similar : gestational age 25 ± 2 versus 25 ± 2 weeks ; body weight 747 ± 233 versus 737 ± 219 g ; clinical risk index for babies 9.8 versus 8.1 ; initial Fi O(2 ) 56 ± 24 versus 52 ± 21 , respectively . LRM began at 86 ± 69 minutes of age and lasted for 61 ± 18 minutes . Groups A and B showed different max PEEP during the first 12 hours of life ( 6.1 ± 0.3 versus 5.3 ± 0.3 cm H (2)O , P=0.00 ) , time to lowest Fi O(2 ) ( 94 ± 24 versus 435 ± 221 minutes ; P=0.000 ) and O(2 ) dependency ( 29 ± 12 versus 45 ± 17 days ; P=0.04 ) . No adverse events and no differences in the outcomes were  observed . LRM led to the earlier lowest Fi O(2 ) of the first 12 hours of life and a shorter O ( 2 ) dependency Background : Appropriate ventilation together with improvement of clinical care of premature babies can contribute to reducing lung inflammation , known to represent the “ primum movens ” of bronchopulmonary dysplasia ( BPD ) . High-frequency oscillatory ventilation ( HFOV ) and volume-guarantee ( VG ) ventilation are effective in the treatment of neonatal respiratory distress syndrome ( RDS ) . Objective : To assess the potential of HFOV and VG to prevent BPD in the acute phase of RDS , by a r and omised clinical study evaluating lung inflammation in premature infants . Study design : Forty infants ( gestational age 25–32 weeks ) with RDS were assigned to assist-control ventilation plus VG ( Vt = 5 ml/kg ) or HFOV ( both with a Dräger Babylog 8000 plus ventilator ) . Levels of interleukin ( IL ) 6 , IL8 and tumour necrosis factor were determined in tracheal aspirate on days 1 , 3 and 7 of life . Results : In the HFOV group IL6 levels were significantly higher on day 3 ( 0.5 ( 0.2 ) vs assisted-control ventilation plus VG group 0.1 ( 0.2 ) ng/ml ) and oxygen dependency was significantly longer ( 36 ( 23 ) vs assisted-control ventilation plus VG group 19 ( 11 ) days ) . Conclusion : VG ventilation is an effective lung-protective strategy to be used in acute RDS , inducing a lower expression of early inflammation markers than HFOV . Whether the use of this initial ventilatory strategy contributes to the prevention of BPD requires further studies The aim of the present study was to evaluate if high-frequency oscillatory ventilation ( HFOV ) might reduce lung inflammation in preterm infants with infant respiratory distress syndrome ( RDS ) in comparison with the early application of another potentially lung-protective ventilation strategy , such as pressure support ventilation plus volume guarantee ( PSV + VG ) . Infants at less than 30 weeks of gestation with RDS were enrolled consecutively in the study if they required mechanical ventilation  , and were r and omly allocated to receive HFOV or PSV + VG . Bronchial aspirate sample s for the measurement of interleukin (IL)-1beta , IL-8 , and IL-10 were obtained before surfactant treatment ( T1 ) , after 6 - 18 hr of ventilation ( T2 ) , after 24 - 48 hr of ventilation ( T3 ) , and before extubation ( T4 ) . Thirteen patients were enrolled in the HFOV group , and 12 in the PSV + VG group . The mean values of IL-1beta , IL-8 , and IL-10 at T4 were lower in the HFOV group than in the PSV + VG group . The present study demonstrates that early treatment with HFOV is associated with a reduction of lung inflammation in comparison with PSV + VG in preterm infants with RDS OBJECTIVE To compare the hospital course and clinical outcome of preterm infants with respiratory distress syndrome treated with surfactant and managed with high-frequency oscillatory ventilation ( HFOV ) or conventional mechanical ventilation ( CV ) as their primary mode of ventilator support . DESIGN A prospect i ve r and omized clinical trial . SETTING Three community-based level III neonatal intensive care units . SUBJECTS A total of 125 neonates who were 35 weeks or less estimated gestation requiring intubation and assisted ventilation for respiratory distress syndrome with arterial to alveolar oxygen ratio less than .50 . INTERVENTIONS Patients were r and omized to continue CV ( 61 patients ) or be changed to HFOV ( 64 patients ) after exogenous surfactant administration ( 100 mg/kg ) . HFOV was used in a strategy to promote lung recruitment and maintain lung volume . Protocol respiratory care guidelines were followed ; otherwise routine care was provided by each neonatal intensive care unit . MEASUREMENTS AND MAIN RESULTS No differences were noted in demographic features between the two study groups . The study population birth weight was 1.51 + /- .47 kg ( mean + /- SD ) , gestational age was 30.9 + /- 2.5 weeks , and study entry age was 2 to 3 hours . Patients r and omized to HFOV demonstrated the following significant findings compared with CV-treated patients : vasopressor support was less intensive ; surfactant redosing was not as frequent ; oxygenation improved more rapidly and remained higher during the first 7 days ; fewer infants required prolonged supplemental oxygen or ventilator support ; treatment failure was reduced ; more patients survived without chronic lung disease at 30 days ; need for continuous supplemental oxygen at discharge was less ; frequency of necrotizing enterocolitis illness was lower ; there were fewer abnormal hearing tests ; and hospital costs were decreased . No differences were seen between the two study groups in the frequency or severity of patent ductus arteriosus , air leak , retinopathy of prematurity , or intraventricular hemorrhage . Length of hospital stay and survival to discharge were similar for HFOV- and CV-treated infants . CONCLUSIONS When used early with a lung recruitment strategy , HFOV after surfactant replacement result ed in clinical outcomes consistent with a reduction in both acute and chronic lung injury . Benefit was evident for preterm infants both less than or equal to 1 kg and more than 1 kg . In addition , early HFOV treatment may have had a more global effect on patient health throughout the hospitalization , result ing in reduced morbidity and decreased health care cost AIM To compare the effects of patient triggered ventilation ( PTV ) with conventional ventilation ( IMV ) in preterm infants ventilated for respiratory distress syndrome ( RDS ) . METHODS Nine hundred and twenty four babies from 22 neonatal intensive care units were assessed . They were under 32 weeks of gestation and had been ventilated for respiratory distress syndrome ( RDS ) for less than 6 hours within 72 hours of birth . The infants were r and omly allocated to receive either PTV or IMV . Analysis was on an “ intention to treat ” basis . Death before discharge home or oxygen therapy at 36 weeks of gestation ; pneumothorax while ventilated ; cerebral ultrasound abnormality nearest to 6 weeks ; and duration of ventilation in survivors were the main outcome measures . RESULTS There was no significant difference in outcome between the two groups . Unadjusted rates for death or oxygen dependency at 36 weeks of gestation were 47.4 % and 48.7 % , for PTV and IMV , respectively ; for pneumothorax these were 13.4 % and 10.3 % ; and for cerebral ultrasound abnormality nearest to 6 weeks these were 35.4 % and 36.9 % . Median duration of ventilation for survivors in both groups was 6 days . Overall , 79 % of babies received only their assigned ventilation . PTV babies were more likely to depart from their intended ventilation ( 27%vs 15 % ) . The trend towards higher pneumothorax rates with PTV occurred only in infants below 28 weeks of gestation ( 18.8 % vs 11.8 % ) . CONCLUSIONS There was no observed benefit from the use of PTV , with a trend towards a higher rate of pneumothorax under 28 weeks of gestation . Although PTV has a similar outcome to IMV for treatment of RDS in infants of 28 weeks or more gestation , within 72 hours of birth , it was ab and oned more often . It can not be recommended for infants of less than 28 weeks ' gestation with the ventilators used in this study BACKGROUND : Mechanical ventilation and surfactants are the st and ard treatment of preterm respiratory distress syndrome ( RDS ) . The effects of the primary ventilation model on bronchopulmonary dysplasia ( BPD ) and long-term neurodevelopment outcomes are controversial . The purpose of this study was to compare the efficacy and safety of high-frequency oscillatory ventilation ( HFOV ) and synchronized intermittent m and atory ventilation plus pressure support ventilation ( SIMV-PSV ) in preterm infants with severe RDS . METHODS : A total of 366 eligible preterm infants were r and omly assigned to treatment with HFOV ( n = 184 ) or SIMV-PSV ( n = 182 ) . Surfactant was applied if PaO2/FIO2 was < 200 mm Hg after 2 hours of ventilation . Primary outcomes were mortality or incidence of BPD . Secondary outcomes were duration of ventilation and hospitalization , surfactant requirements , pneumothorax , retinopathy of prematurity ≥ stage 2 , and neurodevelopment at 18 months of corrected age . RESULTS : Survival and complete outcome data were available for 288 infants at 18 months of corrected age .  The incidence of death or BPD was significantly higher in the SIMV-PSV group ( P = .001 ) . The duration of mechanical ventilation and hospitalization was shorter and the incidence of surfactant requirement and retinopathy of prematurity was lower in the HFOV group ( P < .001 , P = .002 , P = .04 , respectively ) . Moderate or severe neurological disability was less frequent in the HFOV group than in the SIMV-PSV group at 18 months ( P = .03 ) . The combination of HFOV and surfactant dramatically reduced negative outcomes in preterm infants with severe RDS . CONCLUSIONS : Initial ventilation  with HFOV in preterm infants with severe RDS reduces the incidence of death and BPD , and improves long-term neurodevelopment outcomes . ( Clinical Trials.gov NCT01496508 AIM To compare patient triggered , with conventional fast rate , ventilation in a r and omised controlled trial using the incidence of chronic lung disease as the primary outcome measure . METHODS Three hundred and eighty six preterm infants with birthweights from 1000 to 2000 g , and requiring ventilation for respiratory distress syndrome within 24 hours of birth , were r and omised to receive either conventional or trigger ventilation with the SLE 2000 ventilator . RESULTS There were no significant differences in the incidence of chronic lung disease ( 28 day and 36 week definitions ) , death , pneumothorax , intraventricular haemorrhage , number of ventilator days , or length of oxygen dependency between groups . CONCLUSIONS Patient triggered ventilation in preterm infants with respiratory distress syndrome is feasible . No significant differences , when compared with conventional fast rate ventilation in important medium and longer term outcome measures , were evident We conducted a multicenter , prospect i ve , noncrossover , r and omized study to determine whether high-frequency oscillatory ventilation ( HFOV ) would decrease the development or progression of air leak syndrome in infants with severe respiratory distress syndrome . Air leak syndrome was defined as pulmonary interstitial emphysema or gross air leak such as pneumothorax . Infants were eligible for study entry if they were less than 48 hours of age and had severe respiratory distress syndrome , defined by peak inspiratory pressure or the presence of air leak syndrome . Infants who weighed > or = 0.5 kg at birth were r and omly assigned to receive either conventional ventilation ( CV ) or HFOV . HFOV was provided by a ventilator that operated at 15 Hz , with a 1:2 inspiratory/expiratory ratio and no background tidal breaths . Severity of pulmonary interstitial emphysema was scored independently by two neonatologists unaware of the infants ' ventilatory group . Gross air leak severity was scored according to the number of chest tubes required and duration of air leak .  Eighty-six infants received HFOV ;  90 received  CV . During the first 24 hours of the study , patients in the HFOV group received significantly higher mean airway pressure and lower inspired oxygen concentration , had significantly lower arterial carbon dioxide tension , and had a higher ratio of arterial to alveolar oxygen tension . When the HFOV and CV groups were compared with control for birth weight strata , study site , and inborn versus outborn status , HFOV significantly reduced the development of air leak syndrome in those patients who entered the study without the syndrome . We conclude that HFOV , when the strategy employed in this study is used , provides effective ventilation , improves oxygenation , and significantly reduces the development of air leak syndrome in infants with severe respiratory distress syndrome
Introduction The effects of different mechanical ventilation ( MV ) modes on mortality outcome in infants with respiratory distress syndrome ( RDS ) are not well known .