2001 OPEN FORUM Abstracts
EARLYHIGH FREQUENCY OSCILLATORY VENTILATION (HFOV) vs SYNCHRONIZED INTERMITTENT MANDATORYVENTILATION (SIMV) FOR VERY LOW BIRTH WEIGHT (VLBW) INFANTS
Jeanette M. Asselin, DavidJ. Durand (Children?s Hospital Oakland, Oakland, CA), Sherry E. Courtney(Cooper Hospital, Camden, New Jersey), and The Neonatal Ventilation StudyGroup.
Background:Clinical trials comparing high frequency ventilation (HFV) to conventional ventilationhave yielded conflicting results about whether HFV improves pulmonary outcomein VLBW infants. Whether HFV increases severe intraventricular hemorrhage (IVH)and/or cystic periventricular leukomalacia (PVL) is also uncertain.
Objective: Todetermine whether early institution of HFOV, compared to SIMV with continuoustidal volume monitoring, improved the pulmonary outcome of VLBW infants withoutincreasing the incidence of IVH and/or PVL.
Design/ Methods:500 infants from 26 centers were enrolled into a prospective randomized trial.Eligible infants were 601-1200 g birthweight and ventilator-dependent afterone dose of Survanta. Infants were randomized and placed on their assigned ventilatoras soon as possible after birth. Patients were treated with ventilator strategieswhich included permissive hypercapnea, monitoring of lung inflation and tidalvolume, aggressive weaning, and standardized extubation criteria. All infantsreceived prophylactic indomethacin. Neuroultrasounds were done at specifiedtimes and interpreted by a single masked reviewer.
Results: 482patients completed the study.
|Birth weight(gms)||861 ± 161||849± 160||0.42|
|Age randomization(hrs)||2.7 ± 0.9||2.7 ± 0.9||0.72|
|Postnatalsteroid Rx (days)||9.5 ± 12.4||12.3 ± 14.1||0.018|
|Age extubationprim disease (days)||17.3 ± 16.6||24.2 ± 19.2||0.0002|
|Alive w/ochronic lung dis at 36 wk||131||117|
Neuroultrasound resultsindicate no difference in severe IVH and/or PVL.
Conclusions:Early use of HFOV improves pulmonary outcome of VLBW infants, even when comparedto a strategy of tidal ventilation which includes synchronization and targetingtidal volume. HFOV does not increase the incidence of severe IVH or cystic PVL.
Disclosure:Funded in part by the Society for Pediatric Research Multicenter Trials Program,Abbott Laboratories/Ross Products Division, SensorMedics Corp., EME Ltd., BallardMedical, and Natus Medical Products.