Benefits of high frequency oscillatory ventilation for premature infants.

BACKGROUND: High frequency oscillatoryventilation based on optimal lung volume strategy is one of the accepted modes of ventilatory support for respiratory distress syndrome in very low birth weight infants. In 1999 itwas introduced in our unit as the primary ventilation modality for RDS.

OBJECTIVES: To evaluate if the shift to HFOV influenced the outcome of ventilated VLBW infants in the neonatal intensive care unit of Carmel Medical Center.

METHODS: Data were obtained from the medical charts of VLBW infants born at Carmel Medical Center, and late mortality data from the Israel Ministry of Internal Affairs records. A retrospective analysis and a comparison with a historical control group ventilated by the conventional method were performed.

RESULTS: A total of 232 VLBW infants with RDS were mechanically ventilated during the period 1995 to 2003: 120 were ventilated using HFOV during 1999-2003 and 102 infants using CV during 1995-1999. The mean gestational age of survivors was 27.4 +/- 2 weeks in the HFOV group and 28.4 +/- 2 in the conventional ventilation group (P = 0.03). The sub-sample of infants with birth weight < 1000 g ventilated with HFOV showed higher survival rates than the infants in the conventional ventilation group, 53 vs. 25 (64.6% vs. 44.6%) respectively (P < 0.05). A trend for lower incidence of pulmonary interstitial emphysema was observed in the HFOV group.

CONCLUSIONS: The introduction of HFOV based on optimal lung volume strategy proved to be an efficient and safe method of ventilation support for VLBW infants in our unit.