Efficacy and limits of rescue high-frequency oscillatory ventilation in the treatment of severe hyaline membrane disease in preterm neonates

Conflicting reports of high-frequency oscillatory ventilation (HFOV) use as an alternative to conventional mechanical ventilation have been published. This retrospective study has evaluated the efficacy and safety of rescue H FOV in preterm infants with severe hyaline membrane disease (HMD) after the failure of conventional mechanical ventilation (MV). Population and methods. - All newborns hospitalized in our neonatal intensi ve care unit (NICU) from 10.1.1993 to 15.4.1995 with CMV failure, defined a s the need for more than 55% FiO(2) without any improvement for at least si x hours, have been retrospectively studied. The infants were shared accordi ng to the absence (Gr I) or the presence (Gr II) of persistent pulmonary hy pertension of neonate (PPHN) in addition to HMD before HFOV. Results. - Gestational age (GA) was 29.2 +/- 3.7 weeks (mean +/- SD) in GR I and 30.3 +/- 2.8 in Gr II. Birth weight was 1379 +/- 750 g and 1471 +/- 6 12 g, respectively. As soon as three hours after the onset of HFOV in both groups, a dramatic improvement was observed with a FiO(2) drop from 82 +/- 20% to 64.8 +/- 25.5% (P < 0.01). Among the infants 62% survived without an y major disability and 28% died (46% in Gr II vs 12% in Gr I, P < 0.01). A trend towards a worsening of pre-existing brain lesions has been noticed. A n increased risk of mortality was observed when a secondary worsening in O- 2 requirements occurred 24 hours after the onset of HFOV, despite an initia l significant improvement SGA was also associated with a poor prognosis (46 % of the deaths vs 29% for AGA infants, P < 0.05). Conclusion. - HFOV has been successfully used in premature infants with sev ere respiratory disease and failure of CMV. Criteria of poor prognosis were PPHN and SGA, or a secondary worsening in oxygen requirements after initia l improvement. A trend towards aggravation of pre-existing brain lesions ha s been noticed after HFOV. This aggravation is more frequent when PPHN is a ssociated with HMD. This observation suggests caution for HFOV use when the se conditions are present in premature infants. (C) 1999 Editions scientifi ques et medicales Elsevier SAS.