High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants

Sherry E. Courtney, David J. Durand, Jeanette M. Asselin, Mark L. Hudak, Judy L. Aschner, Craig T. Shoemaker

Research output: Contribution to journalArticle

277 Citations (Scopus)

Abstract

Background: The efficacy and safety of early high-frequency oscillatory ventilation as compared with conventional synchronized intermittent mandatory ventilation for the treatment of infants with very low birth weight have not been established. Methods: We conducted a randomized, multicenter clinical trial to determine whether infants treated with early high-frequency oscillatory ventilation were more likely than infants treated with synchronized intermittent mandatory ventilation to be alive without requiring supplemental oxygen at 36 weeks of postmenstrual age. Eligible infants weighed 601 to 1200 g at birth, were less than four hours of age, had received one dose of surfactant, and required ventilation with a mean airway pressure of at least 6 cm of water and a fraction of inspired oxygen of at least 0.25. Infants were stratified according to birth weight and exposure to prenatal corticosteroids and then randomly assigned to high-frequency oscillatory ventilation or synchronized intermittent mandatory ventilation. Ventilation was managed according to protocols designed to optimize lung inflation and blood gas values. Results: Five hundred infants were enrolled in the study. Infants randomly assigned to high-frequency oscillatory ventilation were successfully extubated earlier than infants assigned to synchronized intermittent mandatory ventilation (P<0.001). Of infants assigned to high-frequency oscillatory ventilation, 56 percent were alive without a need for supplemental oxygen at 36 weeks of postmenstrual age, as compared with 47 percent of those receiving synchronized intermittent mandatory ventilation (P=0.046). There was no difference between the groups in the risk of intracranial hemorrhage, cystic periventricular leukomalacia, or other complications. Conclusions: There was a small but significant benefit of high-frequency oscillatory ventilation in terms of the pulmonary outcome for very-low-birth-weight infants without an increase in the occurrence of other complications of premature birth.

Original languageEnglish (US)
Pages (from-to)643-652
Number of pages10
JournalNew England Journal of Medicine
Volume347
Issue number9
DOIs
StatePublished - Aug 29 2002
Externally publishedYes

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High-Frequency Ventilation
Very Low Birth Weight Infant
Artificial Respiration
Ventilation
Oxygen
Periventricular Leukomalacia
Lung
Intracranial Hemorrhages
Premature Birth
Economic Inflation
Birth Weight
Surface-Active Agents
Multicenter Studies
Adrenal Cortex Hormones
Randomized Controlled Trials
Gases
Parturition
Safety
Pressure
Water

ASJC Scopus subject areas

  • Medicine(all)

Cite this

High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants. / Courtney, Sherry E.; Durand, David J.; Asselin, Jeanette M.; Hudak, Mark L.; Aschner, Judy L.; Shoemaker, Craig T.

In: New England Journal of Medicine, Vol. 347, No. 9, 29.08.2002, p. 643-652.

Research output: Contribution to journalArticle

Courtney, Sherry E. ; Durand, David J. ; Asselin, Jeanette M. ; Hudak, Mark L. ; Aschner, Judy L. ; Shoemaker, Craig T. / High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants. In: New England Journal of Medicine. 2002 ; Vol. 347, No. 9. pp. 643-652.
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