Therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation on respiratory failure in preterm infants with a gestational age of 28-34 weeks: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To investigate the therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation (HFOV-VG) versus conventional mechanical ventilation (CMV) in the treatment of preterm infants with respiratory failure.@*METHODS@#A prospective study was conducted on 112 preterm infants with respiratory failure (a gestational age of 28-34 weeks) who were admitted to the Department of Neonatology, Jiangyin Hospital Affiliated to Medical School of Southeast University, from October 2018 to December 2022. The infants were randomly divided into an HFOV-VG group (44 infants) and a CMV group (68 infants) using the coin tossing method based on the mode of mechanical ventilation. The therapeutic efficacy was compared between the two groups.@*RESULTS@#After 24 hours of treatment, both the HFOV-VG and CMV groups showed significant improvements in arterial blood pH, partial pressure of oxygen, partial pressure of carbon dioxide, and partial pressure of oxygen/fractional concentration of inspired oxygen ratio (P<0.05), and the HFOV-VG group had better improvements than the CMV group (P<0.05). There were no significant differences between the two groups in the incidence rate of complications, 28-day mortality rate, and length of hospital stay (P>0.05), but the HFOV-VG group had a significantly shorter duration of invasive mechanical ventilation than the CMV group (P<0.05). The follow-up at the corrected age of 6 months showed that there were no significant differences between the two groups in the scores of developmental quotient, gross motor function, fine motor function, adaptive ability, language, and social behavior in the Pediatric Neuropsychological Development Scale (P>0.05).@*CONCLUSIONS@#Compared with CMV mode, HFOV-VG mode improves partial pressure of oxygen and promotes carbon dioxide elimination, thereby enhancing oxygenation and shortening the duration of mechanical ventilation in preterm infants with respiratory failure, while it has no significant impact on short-term neurobehavioral development in these infants.

Availability of Volume Guaranteed Ventilation in Very Low Birth Weight Infants

PURPOSE: During the last few decades, very low birth weight (VLBW) infants had been treated with time-cycled pressure-limited ventilation. According to a recent study, however, lung damage is much more likely following volutrauma rather than barotrauma. Therefore, other researchers have started to study volume-guaranteed (VG) ventilation as a new method for infant respiratory distress syndrome. The aims of this study are to compare the effects and safety of VG ventilation with conventional intermittent mandatory ventilation (IMV) on mechanical ventilation in VLBW infants with respiratory distress syndrome (RDS). METHODS: A prospective study was performed from Jan, 2005 to Jun, 2006 in Dong-A University Medical Center NICU on 28 VLBW infants who were diagnosed with respiratory distress syndrome. The infants were randomly assigned to IMV or VG ventilation. The IMV and VG groups consisted of sixteen and twelve patients, respectively. We compared arterial blood gas analysis (ABGA), fraction of inspired oxygen (FiO2), peak inspiratory pressure (PIP), mean airway pressure (MAP) and ventilation index (VI) between the two groups during the four days after their birth. RESULTS: The mean gestational age of our infant patients was 27.8 (+/-2.2) weeks in the VG group and 27.7 (+/-2.3) weeks in the IMV group; the mean birth weight was 1103 (+/-239.1) g and 1061.2 (+/-322.4) g, respectively (P>0.05). Although the two groups had a similar FiO2 and VI, PIP and MAP were significantly lower in VG than IMV during the study pediod (P<0.001). There was no significant difference in the complications between the two groups. CONCLUSION: In this study, PIP and MAP are significantly lower in VG group than IMV group. These findings suggest that the new VG ventilation could reduce lung damage in VLBW infants with RDS. To achieve more effective results, this study needs to continue a long term study with a greater number of subjects.