Volume guarantee versus high-frequency ventilation: lung inflammation in preterm infants.
BACKGROUND
Appropriate ventilation together with improvement of clinical care of premature babies can contribute to reducing lung inflammation, known to represent the "primum movens" of bronchopulmonary dysplasia (BPD). High-frequency oscillatory ventilation (HFOV) and volume-guarantee (VG) ventilation are effective in the treatment of neonatal respiratory distress syndrome (RDS).


OBJECTIVE
To assess the potential of HFOV and VG to prevent BPD in the acute phase of RDS, by a randomised clinical study evaluating lung inflammation in premature infants.


METHODS
Forty infants (gestational age 25-32 weeks) with RDS were assigned to assist-control ventilation plus VG (Vt = 5 ml/kg) or HFOV (both with a Dräger Babylog 8000 plus ventilator). Levels of interleukin (IL) 6, IL8 and tumour necrosis factor were determined in tracheal aspirate on days 1, 3 and 7 of life.


RESULTS
In the HFOV group IL6 levels were significantly higher on day 3 (0.5 (0.2) vs assisted-control ventilation plus VG group 0.1 (0.2) ng/ml) and oxygen dependency was significantly longer (36 (23) vs assisted-control ventilation plus VG group 19 (11) days).


CONCLUSIONS
VG ventilation is an effective lung-protective strategy to be used in acute RDS, inducing a lower expression of early inflammation markers than HFOV. Whether the use of this initial ventilatory strategy contributes to the prevention of BPD requires further studies.
Lista
G
G
NICU, Vittore Buzzi Children's Hospital, ICP, Via Castelvetro 32, 20154, Milan, Italy. g.lista@icp.mi.it
Castoldi
F
F
Bianchi
S
S
Battaglioli
M
M
Cavigioli
F
F
Bosoni
M A
MA
D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D005260:Female; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000628:therapy*; D018836:Inflammation Mediators / Q000032:analysis; D007378:Interleukins / Q000032:analysis; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D018836:Inflammation Mediators; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha