PT  - JOURNAL ARTICLE
AU  - Huiqing Sun
AU  - Rui Cheng
AU  - Wengqing Kang
AU  - Hong Xiong
AU  - Chongchen Zhou
AU  - Yinghui Zhang
AU  - Xiaoyang Wang
AU  - Changlian Zhu
TI  - High-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation plus pressure support in preterm infants with severe respiratory distress syndrome
AID  - 10.4187/respcare.02382
DP  - 2013 Jun 12
TA  - Respiratory Care
PG  - respcare.02382
4099  - http://rc.rcjournal.com/content/early/2013/06/13/respcare.02382.short
4100  - http://rc.rcjournal.com/content/early/2013/06/13/respcare.02382.full
AB  - Background: Mechanical ventilation and surfactants are the standard treatment of preterm respiratory distress syndrome (RDS). The effects of the primary ventilation model on bronchopulmonary dysplasia (BPD) and long-term neurodevelopment outcomes are controversial. The purpose of this study was to compare the efficacy and safety of high-frequency oscillatory ventilation (HFOV) and synchronized intermittent mandatory ventilation plus pressure support ventilation (SIMV-PSV) in preterm infants with severe RDS. Methods: A total of 366 eligible preterm infants were randomly assigned to treatment with HFOV (n = 184) or SIMV-PSV (n = 182). Surfactant was applied if PaO2/FIO2 < 200 after 2 hours of ventilation. Primary outcomes were mortality or incidence of BPD. Secondary outcomes were duration of ventilation and hospitalization, surfactant requirements, pneumothorax, retinopathy of prematurity (ROP) ≥ stage 2, and neurodevelopment at 18 months of corrected age. Results: Survival and complete outcome data were available for 288 infants at 18 months of corrected age. Incidence of death or BPD was significantly higher in the SIMV-PSV group (p = 0.001). The duration of mechanical ventilation and hospitalization was shorter and the incidence of surfactant requirement and ROP was lower in the HFOV group (p < 0.05). Moderate or severe neurological disability was less frequent in the HFOV group than in the SIMV-PSV group at 18 months (p < 0.05). The combination of HFOV and surfactant dramatically reduced negative outcomes in preterm infants with severe RDS. Conclusion: Initial ventilation with HFOV in preterm infants with severe RDS reduces the incidence of death and BPD and improves long-term neurodevelopment outcomes.