The Science Journal of the American Association for Respiratory Care

1995 OPEN FORUM Abstracts

IMPROVED OXYGENATION IN RDS WITH EARLY HFOV COMPARED TO CV: THE PROVO MULTICENTER CONTROLLED CLINICAL TRIAL.

Dale Gerstmann MD, Stephen Minton MD, Ronald Stoddard MD, and Gordon Lassen RRT, Utah Valley Reg Med Cen, Provo, UT; Keith Meredith MD and Frank Monaco RRT, Memorial Hospital, Colorado Springs, CO; Jean Marie Bertrand MD, O Battisti MD, JP Langhendries MD and A Francois, Clinique Saint Vincent, Rocourt, Belgium.

Introduction: We evaluated the oxygenation and ventilation response in preterm infants< =35wks GA with RDS who required ventilator support, received exogenous surfactant, and were randomly assigned to either HFOV or CV. Method: In a multicenter randomized controlled clinical trial without crossover 64 neonates were assigned to HFOV and 61 to CV. HFOV was used with a strategy to promote early rapid lung recruitment. Repeat surfactant doses were given for P_{a/A}O_2 < 0.50. All blood gas values during the 1st 7d of life were collected along with ventilator settings at the time of blood gas draw (n=4512). Each patient's blood gas values were averaged within the following intervals: -4 to Oh, 0-2h, 4±2h intervals to 24h, 8±3h intervals to 48h, 12±4h intervals to 7d. All averaged patient values were then pooled for HFOV and CV grp analysis using ANOVA (Repeated Measures).

Results: Birth weight and estimated GA were 1.56±0.46 vs 1.46±0.47 kg, and 30.8±2.2 vs 30.1±2.7 wk for HFOV and CV grps respectively. Age at study start was 2-3h of life. P_{aw} was significantly higher over the 1st wk of life for the HFOV grp, p < 0.0001. HFOV F_iO_2 levels were weaned to< 0.30 by 8h, with F_iO_2 at all timepoints up to 48h lower than with CV, p < 0.05 each. P_{a/A}O_2 rapidly increased with HFOV to >0.50 by 4h into the study, with values in intervals between 4-36h exceeding those for CV, p < 0.05 each. F_iO_2 and P_{a/A}O_2 were significantly improved with HFOV compared to CV over the first week (p < 0.00001, each). PCO_2 values were the same between grps over the 1st 7d of the study. The number of HFOV patients receiving >1dose surfactant was less, 16% vs 46%, p < 0.0004.

Conclusions: Using HFOV early in the course of RDS with a treatment strategy objective to reverse atelectesis and improve lung volume through the use of P_{aw}, we were able to significantly improve oxygenation but yet decrease the frequency of subsequent surfactant dosing. (Partial funding for data review was provided by grants from Ross Laboratories and SensorMedics Critical Care.)

OF-95-228

You are here: RCJournal.com » Past OPEN FORUM Abstracts » 1995 Abstracts » IMPROVED OXYGENATION IN RDS WITH EARLY HFOV COMPARED TO CV: THE PROVO MULTICENTER CONTROLLED CLINICAL TRIAL.