CLINICAL-EXPERIENCES WITH HIGH-FREQUENCY OSCILLATORY VENTILATION IN NEWBORNS WITH SEVERE RESPIRATORY-DISTRESS SYNDROME

Objective: To generate hypotheses about which subgroups of newborns wi th severe respiratory distress syndrome might benefit most from high-f requency oscillatory ventilation. Design: Retrospective analysis of a case series of newborns with severe respiratory distress syndrome who were treated in our department with high-frequency oscillatory ventila tion. Setting: Referral center for neonatal and pediatric intensive ca re medicine. Patients: All newborns (n = 18), admitted between June 19 91 and February 1993, of various gestational ages (26 to 41 wks), with severe respiratory distress syndrome caused by various underlying pul monary diseases who did not respond to conventional therapy and who th us were treated with high-frequency oscillatory ventilation. Main Outc ome Measures: Survival until discharge from our unit and persistent im provement of gas exchange. Results: Eight (44%) of 18 patients survive d; ten (55%) patients died. Four (22%) survivors showed marked clinica l improvement with the initiation of high-frequency oscillatory ventil ation. Four (22%) survivors did not respond to high-frequency oscillat ory ventilation. The responder group consisted of term or near-term ne onates (gestational age at least 35 wks) with pulmonary disease that w as complicated by persistent pulmonary hypertension. The group of prem ature neonates with a gestational age of <35 wks did not respond to hi gh-frequency oscillatory ventilation. Conclusions: As a result of our analysis, we hypothesize that term newborns with severe respiratory di stress syndrome complicated by persistent pulmonary hypertension and h ypercarbia can benefit from high-frequency oscillatory ventilation. Pr emature neonates with ventilation-induced lung injury are not likely t o respond to high-frequency oscillatory ventilation.