High-Frequency Oscillatory Ventilation for the Prevention of Chronic Lung Disease of Prematurity

TLDR

Uncertainty remains about the safety and efficacy of high‑frequency oscillatory ventilation versus conventional ventilation for respiratory support of very preterm infants, and long‑term effects require further follow‑up. The study aimed to determine whether early high‑frequency oscillatory ventilation reduces mortality and chronic lung disease in infants born at 28 weeks gestation or less. A multicenter, stratified randomized trial assigned 400 infants (≤28 weeks) to high‑frequency oscillatory ventilation and 397 to conventional ventilation within one hour of birth. The composite outcome of death or chronic lung disease occurred in 66 % of the HFOV group versus 68 % of the conventional group (RR 0.98, 95 % CI 0.89–1.08), with no significant differences in mortality, chronic lung disease, treatment failure, or secondary outcomes between the groups.

Abstract

There remains uncertainty concerning the safety and efficacy of high-frequency oscillatory ventilation as compared with those of conventional ventilation for the respiratory support of very preterm infants. We conducted a multicenter trial to determine whether early intervention with high-frequency oscillatory ventilation reduced mortality and the incidence of chronic lung disease among newborns with a gestational age of 28 weeks or less.We randomly assigned preterm infants with a gestational age of 23 to 28 weeks to either conventional ventilation or high-frequency oscillatory ventilation within one hour after birth. Randomization was stratified according to center and gestational age (23 to 25 weeks or 26 to 28 weeks).A total of 400 infants were assigned to high-frequency oscillatory ventilation, and 397 were assigned to conventional ventilation. The composite primary outcome (death or chronic lung disease, diagnosed at 36 weeks of postmenstrual age) occurred in 66 percent of the infants assigned to receive high-frequency oscillatory ventilation and 68 percent of those in the conventional-ventilation group (relative risk in the group assigned to high-frequency oscillatory ventilation, 0.98; 95 percent confidence interval, 0.89 to 1.08). Similar proportions of infants died or had chronic lung disease in each gestational-age group. In both treatment groups treatment failure occurred in 10 percent of infants (relative risk in the group assigned to high-frequency oscillatory ventilation, 0.99; 95 percent confidence interval, 0.66 to 1.50). There were no significant differences between the groups in a range of other secondary outcome measures, including serious brain injury and air leak.The results obtained with high-frequency oscillatory ventilation and conventional ventilation do not differ significantly in the early treatment of respiratory disease in very preterm infants. Assessment of long-term effects will require additional follow-up.