First intention high-frequency oscillation with early lung volume optimization improves pulmonary outcome in very low birth weight infants with respiratory distress syndrome

Objectives. The lack of decline in chronic lung disease of prematurity desp ite the generalized use of surfactant and alternative modes of ventilation such as high-frequency oscillation (HFO) has been attributed to some misund erstanding of how HFO has to be used. We used a new ventilatory strategy in very low birth weight (VLBW) infants, by initiating HFO immediately after intubation and attempting early lung volume optimization before surfactant was administered. Study Design. The outcome of 32 VLBW infants, managed with first intention HFO over a period of 24 months (September 1, 1996 and August 31, 1998) was compared by chart review with 39 historical controls, consecutively managed with conventional mechanical ventilation (CMV) over a period of 24 months (January 1, 1994 and December 31, 1995). Setting. An 11-bed tertiary care pediatric and neonatal intensive care unit of a university teaching hospital. Results. The 2 groups of patients were similar in demographic distribution of birth weight, gestational age, race, and gender. Patients on first inten tion HFO were ventilator-dependent (median [95% confidence interval]: 5 [3- 6] vs 14 [6-23] days) and oxygen-dependent (12 [4-17] vs 51 [20-60] days) f or a shorter time than patients on CMV. The incidence of chronic lung disea se at 36 weeks of gestational age was significantly lower in the HFO group compared with the CMV group (0% vs 34%). Conclusions. First intention HFO with early lung volume optimization shorte ned the need for respiratory support and improved pulmonary outcome of VLBW infants with respiratory distress syndrome significantly.