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High-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation plus pressure support in preterm infants with severe respiratory distress syndrome

Artikel i vetenskaplig tidskrift
Författare H. Sun
R. Cheng
W. Kang
H. Xiong
C. Zhou
Y. Zhang
Xiaoyang Wang
C. Zhu
Publicerad i Respiratory care
Volym 59
Nummer/häfte 2
Sidor 159-169
ISSN 0020-1324
Publiceringsår 2014
Publicerad vid Institutionen för neurovetenskap och fysiologi
Institutionen för neurovetenskap och fysiologi, sektionen för fysiologi
Sidor 159-169
Språk en
Länkar dx.doi.org/10.4187/respcare.02382
Ämnesord High-frequency oscillatory ventilation, Neurodevelopment, Preterm infants, Respiratory distress syndrome
Ämneskategorier Neurovetenskaper

Sammanfattning

BACKGROUND: Mechanical ventilation and surfactants are the standard 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 mandatory ventilation plus pressure support ventilation (SIMV-PSV) in preterm infants with severe RDS. METHODS: A total of 366 eligible preterm infants were randomly 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. (ClinicalTrials.gov NCT01496508). © 2014 Daedalus Enterprises.

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