PEDIATRICS Vol. 89 No. 1 January 1992, pp. 5-12
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Prospective Randomized Comparison of High-Frequency Oscillatory and Conventional Ventilation in Respiratory Distress Syndrome

Reese H. Clark MD1, Donald M. Null Jr MD1, Dale R. Gerstmann MD2, and Robert A. deLemos MD2

1 From the Wilford Hall USAF Medical Center, Lackland AFB, TX
2 From the Southwest Foundation for Biomedical Research, San Antonio, TX.

A prospective randomized trial with a crossover design was conducted to compare the efficacy and safety of two distinct strategies of high-frequency oscillatory ventilation (HFOV) to conventional intermittent mandatory ventilation (CV) in the management of respiratory distress syndrome. Only premature neonates with a birth weight less than 1.751 kg were eligible for enrollment into the study. Of 83 patients studied, 26 patients were assigned to CV-only, 27 to HFOV for 72 hours followed by CV (HFOV/CV), and 30 to HFOV-only until extubation. There was no difference among the three groups with respect to the incidence of pulmonary airleak, intraventricular hemorrhage, or death. The highest incidence of chronic lung disease was in the CV-only group. Although both HFOV groups had a lower incidence of chronic lung disease assessed at 30 days and 36weeks postconception age, the difference was statistically significant only between the CV-only and HFOV-only groups (65% vs 30% at 30 days; P = .008; 38% vs 10% at 36 weeks postconception age, P = .013). These results suggest that use of HFOV as the predominant mode of ventilation in the management of respiratory distress syndrome is as safe as CV and can contribute to a decreased incidence of chronic lung disease. Furthermore, a short (72-hour) period of HFOV support does not provide the same advantage as continuous HFOV.

Key Words: hyaline membrane disease • bronchopulmonary dysplasia • high-frequency oscillatory ventilation

Submitted on October 8, 1990
Accepted on January 15, 1991




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