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 - 2014 Feb 01 TA - Respiratory Care PG - 159--169 VI - 59 IP - 2 4099 - http://rc.rcjournal.com/content/59/2/159.short 4100 - http://rc.rcjournal.com/content/59/2/159.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 was < 200 mm Hg 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 ≥ 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. The incidence of death or BPD was significantly higher in the SIMV-PSV group (P = .001). The duration of mechanical ventilation and hospitalization was shorter and the incidence of surfactant requirement and retinopathy of prematurity was lower in the HFOV group (P < .001, P = .002, P = .04, respectively). Moderate or severe neurological disability was less frequent in the HFOV group than in the SIMV-PSV group at 18 months (P = .03). The combination of HFOV and surfactant dramatically reduced negative outcomes in preterm infants with severe RDS. CONCLUSIONS: Initial ventilation with HFOV in preterm infants with severe RDS reduces the incidence of death and BPD, and improves long-term neurodevelopment outcomes. (ClinicalTrials.gov NCT01496508)