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Previous Volume 347:643-652 August 29, 2002 Number 9 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Slutsky, A. S. Editorial by Stark, A. R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The efficacy and safety of early high-frequency oscillatory ventilation as compared with conventional synchronized intermittent mandatory ventilation for the treatment of infants with very low birth weight have not been established.

Methods We conducted a randomized, multicenter clinical trial to determine whether infants treated with early high-frequency oscillatory ventilation were more likely than infants treated with synchronized intermittent mandatory ventilation to be alive without requiring supplemental oxygen at 36 weeks of postmenstrual age. Eligible infants weighed 601 to 1200 g at birth, were less than four hours of age, had received one dose of surfactant, and required ventilation with a mean airway pressure of at least 6 cm of water and a fraction of inspired oxygen of at least 0.25. Infants were stratified according to birth weight and exposure to prenatal corticosteroids and then randomly assigned to high-frequency oscillatory ventilation or synchronized intermittent mandatory ventilation. Ventilation was managed according to protocols designed to optimize lung inflation and blood gas values.

Results Five hundred infants were enrolled in the study. Infants randomly assigned to high-frequency oscillatory ventilation were successfully extubated earlier than infants assigned to synchronized intermittent mandatory ventilation (P<0.001). Of infants assigned to high-frequency oscillatory ventilation, 56 percent were alive without a need for supplemental oxygen at 36 weeks of postmenstrual age, as compared with 47 percent of those receiving synchronized intermittent mandatory ventilation (P=0.046). There was no difference between the groups in the risk of intracranial hemorrhage, cystic periventricular leukomalacia, or other complications.

Conclusions There was a small but significant benefit of high-frequency oscillatory ventilation in terms of the pulmonary outcome for very-low-birth-weight infants without an increase in the occurrence of other complications of premature birth.

Source Information

From the Division of Neonatology, Cooper Hospital–University Medical Center, Camden, N.J. (S.E.C.); the Division of Neonatology (D.J.D.) and the Neonatal–Pediatric Research Group (J.M.A.), Children's Hospital and Research Center at Oakland, Oakland, Calif.; the Division of Neonatology, University of Florida at Jacksonville, and the Division of Neonatology, Wolfson Children's Hospital, Jacksonville, Fla. (M.L.H.); the Division of Neonatology, Wake Forest University School of Medicine, Winston-Salem, N.C. (J.L.A.); and MeritCare Children's Hospital, Fargo, N.D. (C.T.S.).

Address reprint requests to Dr. Courtney at the Division of Neonatology, Schneider Children's Hospital, Long Island Jewish Medical Center, 270-05 76th Ave., New Hyde Park, NY 11040, or at scourtney{at}lij.edu.

Full Text of this Article

Related Letters:

High-Frequency Ventilation
Thome U. H., Pohlandt F., Kabra N. S., Courtney S. E., Durand D. J., Asselin J. M.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:1181-1182, Mar 20, 2003. Correspondence

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