HIGH-FREQUENCY OSCILLATING VENTILATION IN PREMATURE-INFANTS LESS-THAN-1500 G

In 58 premature infants with a birthweight <1500 g High-Frequency-Osci llating-Ventilation (HFOV) was initiated within the first 48 hours of life, Indications for HFOV were: no response to surfactant application (N=41), respiratory distress syndrome without surfactant application (N=9), pulmonary interstitial emphysema (N=8). Mean gestational age of the enrolled patients was 27.6 weeks (24-32) and mean birthweight was 964 g (490-1450). 23 infants died, 5 from non-pulmonary causes. Of th e remainder 2 had B-Strept.-septicemia, 1 lunghypoplasia, and 1 patien t died on the 70th day of life from chronic lung disease. There were n o statistical differences between survivors and nonsurvivors in gestat ional age, birthweight, umbilical pH, 1 min APGAR score or time on con ventional ventilation prior to HFOV, Alveolar-arterial-O2-difference d ropped in the group of surviving patients from x 487 mm Hg (sd+/-60) t o 252 mm Hg (sd+/-89) after 6 hours (p<0.0001) and in the nonsurvivors from x517mm Hg (sd+/-74) to x373mm Hg (sd+/-106) (p=O.002). Oxygenati onindex fell from x25 (sd+/-10) to x 5 (sd+/-1.5) in the survivors and from 25 (sd+/-11) to x9 (sd+/-5.5) in the nonsurvivors within 6 hours (p<0.0001). Mean airway pressure could be lowered in survivors from x 7.6 cm H2O (sd+/-0.6) to 5.3 cm H2O (sd+/-0.8) and in nonsurvivors fro m x8.6cm H2O (sd+/-0.6) to 5.7cm H2O (sd+/-0.9) (p=0.0002). The promis ing results of HFOV as a rescue therapy require a controlled study for its use as a primary mode of ventilation in premature infants.