HFOV in premature neonates: effects on pulmonary mechanics and epithelial lining fluid cytokines. A randomized controlled trial.
OBJECTIVE
Ventilation strategies for preterm neonates may influence the severity of pulmonary dysfunction and later development of chronic lung disease. The objective of this report is to compare the effects of high-frequency oscillatory ventilation (HFOV) versus synchronized intermittent mandatory ventilation (sIMV) from the points of views of biochemical and functional variables.


METHODS
Randomized controlled trial.


METHODS
Third level NICU.


METHODS
Forty preterm neonates with a gestational age of 24-29 weeks were randomly assigned to one of the two above-mentioned ventilation strategies within 30 min from birth.


RESULTS
At 1, 3, 5, and 7 days, the babies were monitored by means of ventilator indices, pulmonary function, and eight pro-inflammatory or anti-inflammatory cytokines measured in bronchoalveolar lavage fluid. The neonates assigned to the HFOV procedure benefited from early and sustained improvement in pulmonary mechanics and gas exchange-significantly higher dynamic respiratory compliance values, significantly lower expiratory airway resistance and oxygenation index values-with earlier extubation as compared to the neonates assigned to sIMV treatment, and showed significantly lower transforming growth factor-beta1 concentrations in bronchoalveolar lavage fluid.


CONCLUSIONS
The results of this randomized clinical trial support the hypothesis that early and exclusive use of HFOV, combined with optimum volume strategy, has a beneficial effect during the acute phase of lung injury.
Vento
Giovanni
G
Division of Neonatology, Department of Paediatrics, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy. vento@rm.unicatt.it
Matassa
Piero G
PG
Ameglio
Franco
F
Capoluongo
Ettore
E
Zecca
Enrico
E
Tortorolo
Luca
L
Martelli
Mara
M
Romagnoli
Costantino
C
D001826:Body Fluids / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D012121:Respiration, Artificial / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D015656:Respiratory Mechanics; D020545:Respiratory Mucosa / Q000276:immunology* / Q000378:metabolism*; D016019:Survival Analysis; D016212:Transforming Growth Factor beta / Q000378:metabolism; D053773:Transforming Growth Factor beta1; D016896:Treatment Outcome
D016207:Cytokines; C508960:TGFB1 protein, human; D016212:Transforming Growth Factor beta; D053773:Transforming Growth Factor beta1
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