Prospective randomized multicenter comparison of high-frequency oscillatory ventilation and conventional ventilation in preterm infants of less than 30 weeks with respiratory distress syndrome

Background. Early use of high-frequency ventilation and exogenous surfactan t is proposed as the optimal mode of ventilatory support in infants with re spiratory distress syndrome. In very premature infants, we tested the hypot hesis that high-frequency versus conventional ventilation could decrease ex ogenous surfactant requirements and improve pulmonary outcome, without alte ring the complication rate, including that of severe intraventricular hemor rhage. Methods. Preterm infants with a postmenstrual age of 24 to 29 weeks, presen ting with respiratory distress syndrome were randomly assigned to high-freq uency oscillatory ventilation (lung volume recruitment strategy) or convent ional ventilation. Results. Two hundred seventy-three infants were enrolled. One hundred fifty -three had a postmenstrual age of 24 to 27 weeks, and 143 had a birth weigh t less than or equal to 1000 g. One hundred thirty-four infants were random ized at 142 minutes of life (median) to receive conventional ventilation (m ean postmenstrual age at birth: 27.6 +/- 1.5 weeks; mean birth weight: 997 +/- 245 g); and 139 infants were randomized at 145 minutes of life to recei ve high-frequency ventilation (mean postmenstrual age at birth: 27.5 +/- 1. 4 weeks; mean birth weight: 976 +/- 219 g). High-frequency ventilation, compared with conventional ventilation, was ass ociated with a twofold reduction in the requirement for greater than or equ al to2 instillations of exogenous surfactant (30% vs 62%; odds ratio:.27; 9 5% confidence interval:.16-.44) and no difference in pulmonary outcome. The incidence of severe intraventricular hemorrhage was 24% in the high-freque ncy group and 14% in the conventional ventilation group (adjusted odds rati o: 1.50; 95% confidence interval:.68-3.30). Conclusion. Early use of high-frequency oscillatory ventilation in very pre mature infants decreases exogenous surfactant requirements, does not improv e the pulmonary outcome, and may be associated with an increased incidence of severe intraventricular hemorrhage.