HIGH-FREQUENCY JET VENTILATION IN THE EARLY MANAGEMENT OF RESPIRATORY-DISTRESS SYNDROME IS ASSOCIATED WITH A GREATER RISK FOR ADVERSE OUTCOMES

Objective. The objective of this investigation was to determine if hig h-frequency jet ventilation (HFJV) used early in the treatment of prem ature infants with respiratory distress syndrome was effective in redu cing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes. Study Design. A total of 73 premature infants who met the inclusion criteria (gestational age of less than 33 weeks, bi rth weight of more than 500 g, age of less than 24 hours, need for ass isted ventilation with peak inspiratory pressure of more than 16 and F IO2 more than 0.30, and roentgenographic evidence of respiratory distr ess syndrome) were randomized to either conventional (n = 36) or to hi gh-frequency jet (n = 37) ventilation. Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they cou ld either be extubated or meet crossover criteria. Univariate analyses were initially used to compare the two groups. Stepwise logistic regr ession was subsequently used to assess whether various factors indepen dently influenced adverse outcomes. Results. The two groups of infants were similar in all obstetrical, perinatal, and neonatal demographic characteristics. The mean birth weight and gestational age in the conv entional group were 930 g and 26.6 weeks and in the HFJV group, 961 g and 26.9 weeks. The infants were randomized at similar ages (7.1 and 7 .3 hours of life, respectively). Their prerandomization ventilator set tings and arterial blood gases were nearly identical. There were no di fferences in pulmonary outcomes (occurrence of air leaks, need for oxy gen or ventilation at 36 weeks postconception), and there were no diff erences in the mean number of days oxygen was required, number of days ventilated, or length of hospital stay. Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leuko malacia (10 vs 2, P = .022) or to have a poor outcome (grade IV hemorr hage, cystic periventricular leukomalacia, or death) (17 vs 7, P = .01 6). Logistic regression analysis revealed HFJV to be a significant ind ependent predictor of both cystic periventricular leukomalacia and a p oor outcome. The presence of hypocarbia was not an independently signi ficant predictor of adverse outcomes. Conclusions. With the HFJV treat ment strategy that we used, use of the high-frequency jet ventilator i n the early management of premature infants with respiratory distress syndrome resulted in significantly more adverse outcomes than in those treated with conventional mechanical ventilation.