BACKGROUND: Mid-frequency ventilation, a strategy of using conventional ventilators at high frequencies, may reduce lung injury but has had limited evaluation in neonates. Hence, a randomized crossover study was designed to assess the feasibility of using mid-frequency ventilation in preterm infants with respiratory distress syndrome.
METHODS: Twelve preterm infants (≥500 g and ≥24 weeks gestational age) who were receiving pressure-limited conventional ventilation with frequencies ≤60 breaths/min for respiratory distress syndrome were randomized to periods of mid-frequency ventilation (conventional ventilation with the fastest frequency up to 150 breaths/min that gave complete inspiration and expiration) or conventional ventilation (frequency ≤60 breaths/min), each lasting 2 h using a crossover design. Ventilator parameters were adjusted to maintain the O2 saturation and transcutaneous CO2 at baseline.
RESULTS: Mean peak inspiratory pressure (15 ± 4 cm H2O vs 18 ± 4 cm H2O, P < .001), Δ pressure (9.8 ± 3.3 cm H2O vs 13.5 ± 3.9 cm H2O, P < .001), and tidal volume (2.6 ± 0.4 mL/kg vs 4.6 ± 0.8 mL/kg, P < .001) were lower, but mean airway pressure (8.9 ± 1.9 cm H2O vs 8.4 ± 1.6 cm H2O, P = .02) and measured PEEP (5.1 ± 0.5 cm H2O vs 4.4 ± 0.5 cm H2O, P < .001) were higher with mid-frequency compared with conventional ventilation. FIO2, gas exchange, and hemodynamic parameters were not affected.
CONCLUSIONS: Based on this small study, mid-frequency ventilation among preterm infants with respiratory distress syndrome is feasible. Further larger and longer duration trials are necessary to validate our findings. (ClinicalTrials.gov registration NCT01242462)
- Correspondence: Waldemar A Carlo MD, Division of Neonatology, 176F Suite 9380, Women and Infants Center, University of Alabama at Birmingham, 619 20th Street South, Birmingham, AL 35233. E-mail: .
This work was supported by the Perinatal Health and Human Development Research Program of the University of Alabama at Birmingham, and Children's of Alabama Centennial Scholar Fund. Mr Chatburn and Dr Mireles-Cabodevila are the inventors named on the patent for mid-frequency ventilation that is assigned to the Cleveland Clinic. Mr Chatburn has disclosed relationships with CareFusion, Covidien, Dräger, Hamilton, IngMar, Inogen, Invacare, Philips, ResMed, Neotech, and Breathe Technologies. Mr Chatburn also holds US patent 4,589,409. Mr Chatburn received royalties from Amazon.com for books on research and mechanical ventilation. Dr Carlo is on the board of directors of Mednax. The other authors have disclosed no conflicts of interest.
Dr Kelleher presented a version of this paper at the Pediatric Academic Societies 2014 annual meeting, held May 3–6, 2014, in Vancouver, Canada.
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