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High-Frequency Oscillatory Ventilation in Premature Infants with Respiratory Failure

A Preliminary Report

Received from the Departments of Anaesthesia, Physiology, Paediatrics, and Pathology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.

Abstract

High-frequency ventilation has been used successfully to manage life-threatening complications in premature infants with lung disease. Here we report a preliminary assessment of the efficacy and safety of high-frequency oscillatory ventilation-(HFO-A, A = active expiratory phase) when used as a primary ventilator in 11 infants of 24–34 weeks gestation who required ventilatory support. HFO-A was initiated after no more than 5.5 hr of conventional mechanical ventilation (CMV). HFO-A at 15 Hz was used for 12–203 hr following a protocol designed for rapid reduction of FI_o2 requirements. CO₂ elimination was easily achieved in all infants. Oxygenation was satisfactory, except in one infant with congenital pneumonia. There were four deaths during HFO-A: two pulmonary (one congenital pneumonia; one pulmonary hemorrhage) and two nonpulmonary. The HFO-A protocol utilized lung volume recruitment maneuvers plus mean airway pressures (MAwP) greater than those generally used early in the course of CMV. Therefore, in a subset of infants 29 weeks' gestation with respiratory distress syndrome (RDS), ventilator pressures and gas exchange were compared in infants treated with either HFO-A or CMV. Maximum MAwP levels were reached earlier in six infants on HFO-A (5.2 ± 2.5 hr; mean ± SD) than in a comparable group of 9 CMV -treated infants (36 ± 1 hr). This earlier use of high MAwP lowered the Fl_O2 to < 0.4 by 18.9 ± 11 hr with HFO-A as compared with 64 ± 6 hr using CMV, without any evidence of an increase in pulmonary complications. There were 17 complications in the nine CMV -treated infants; and four in the six HFO-A treated ones. We conclude that HFO-A, instituted early and used with a protocol designed for early reduction in FI_o2 requirements, demonstrates sufficient efficacy and safety to warrant further clinical trials in the routine management of infant RDS.

Key Words: VENTILATION—high frequency • INTENSIVE CARE—pediatric.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999