Impact of Volume Guarantee on High-Frequency Oscillatory Ventilation in Preterm Infants: A Randomized Crossover Clinical Trial


Iscan B., DUMAN N., Tuzun F., KUMRAL A., ÖZKAN H.

NEONATOLOGY, vol.108, no.4, pp.277-282, 2015 (SCI-Expanded, Scopus) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 108 Issue: 4
  • Publication Date: 2015
  • Doi Number: 10.1159/000437204
  • Journal Name: NEONATOLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.277-282
  • Keywords: High-frequency oscillatory ventilation, Hypocarbia, Optimal lung volume strategy, Randomized controlled trial, Premature infant, Ventilator-induced lung injury, Volume guarantee, Volume-targeting ventilation
  • Dokuz Eylül University Affiliated: Yes

Abstract

Background: High-frequency oscillatory ventilation (HFOV) with volume guarantee (VG) is a new ventilation mode that allows the clinician to set a mean tidal volume to be delivered. Objective: This study aimed to investigate whether HFOV with a VG option may result in constant tidal volume delivery and less fluctuant CO2 levels compared to HFOV alone in premature infants with respiratory distress syndrome (RDS). Methods: Inborn infants at less than 32 weeks of gestation with RDS requiring invasive mechanical ventilation were eligible. Patients were randomized to receive HFOV + VG or HFOV alone as the initial ventilator mode and then crossed over to the other mode. HFOV was performed with 'optimal lung volume strategy' during both of the periods. Results: Twenty infants were evaluated. The mean highfrequency tidal volume (VT hf) and CO2 diffusion coefficient (DCO2) were significantly higher in the HFOV + VG mode than HFOV alone. HFOV + VG maintains VThf within the target range more consistently than HFOV. The incidences of hypocarbia and hypercarbia were lower in HFOV with VG than HFOV alone. Conclusion: This is the first prospective, randomized, short-term crossover clinical study that compared HFOV with and without VG in infants with acute RDS. Because of the lower VThf fluctuation and lower incidences of out-of-target PCO2 levels, HFOV combined with VG seems to be feasible for preterm infants. However, the results should be interpreted with caution due to the small sample size and short-term crossover design of the study. (C) 2015 S. Karger AG, Basel