High frequency oscillatory ventilation: initial experience in 22 patients.

OBJECTIVES

To report the outcome of a consecutive cohort of neonates treated with high frequency oscillatory ventilation (HFOV).

METHODOLOGY: Prospective cohort study of 22 neonates failing conventional mechanical ventilation (CMV) between October 1992 and August 1993. Outcomes evaluated were in-hospital survival rate, comorbidities including patent ductus arteriosus (PDA), cerebroventricular haemorrhages (CVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), and acute changes in respiratory status.

RESULTS

Eighteen of 22 (81.8%) survived. Of the four children who died, one did not respond to HFOV and died within 24 h of treatment. Two died of respiratory failure complicated by pulmonary haemorrhage. The remaining infant responded to HFOV but later developed severe NEC while on minimal CMV and died at 2 weeks of age. Three subjects were > or = 34 weeks' gestation; each responded well to HFOV with no substantial comorbidity. Of the remaining 19 infants < 34 weeks' gestation, six (31.6%) had a PDA, and seven (36.8%) had a CVH. One infant developed cystic periventricular leucomalacia. Three infants (15.8%) had NEC. Respiratory failure in the 15 survivors with gestational ages < 34 weeks improved dramatically with HFOV. Ten (66.7%) survivors < 34 weeks developed BPD and 10 (66.7%) ROP.

CONCLUSION

High frequency oscillatory ventilation was associated with a survival rate of 81.8%, but with significant comorbidity.