Comparable effect of conventional ventilation versus early high-frequency oscillation on serum CC16 and IL-6 levels in preterm neonates.
OBJECTIVE
Clara cell 16 kD protein (CC16) and interleukin (IL)-6 have been used as peripheral blood biomarkers of alveolar leakage and inflammation, respectively. Thus, their measurement in the bloodstream could be used to assess ventilator-induced lung injury. The objective of this study was to evaluate the effect of optimized synchronized intermittent mandatory ventilation (SIMV) and high-frequency oscillatory ventilation (HFOV) on circulating CC16 and IL-6 levels when used as the initial ventilation modes in preterm neonates.


METHODS
Single center, prospective, randomized clinical study in preterm neonates (gestational age 30 weeks) requiring mechanical ventilation within the first 2 h of life. Serum CC16 and IL-6 were measured on establishment of the assigned ventilation mode after admission, at days 3 and 14 of life as well as at 36 weeks postmenstrual age. Demographic-perinatal data and clinical parameters were also recorded.


RESULTS
Of the 30 neonates studied, 24 (gestational age 27.1±1.7 weeks, birth weight 942±214 g) were finally analyzed, equally assigned into the SIMV and HFOV groups. Both groups had comparable demographic-perinatal characteristics and clinical parameters. Serum CC16 and IL-6 altered significantly over time (repeated-measures analysis of variance, both P<0.001). However, changes were not affected by the ventilation mode. Post hoc analysis showed a significant decrease in CC16 and IL-6 from birth up to 36 weeks postmenstrual age in both groups.


CONCLUSIONS
In preterm neonates, SIMV and HFOV are associated with comparable circulating CC16 and IL-6 levels. These findings suggest a similar alveolar leakage and systemic inflammation with any of the ventilation modes evaluated when their usage is optimized.
Sarafidis
K
K
First Department of Neonatology, Aristotle University of Thessaloniki, Thessaloniki, Greece. saraf@med.auth.gr
Stathopoulou
T
T
Agakidou
E
E
Taparkou
A
A
Soubasi
V
V
Diamanti
E
E
Drossou
V
V
D015415:Biomarkers; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015850:Interleukin-6 / Q000378:metabolism*; D012127:Respiratory Distress Syndrome, Newborn / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy*; D014598:Uteroglobin / Q000378:metabolism*; D055397:Ventilator-Induced Lung Injury / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control*
D015415:Biomarkers; D015850:Interleukin-6; C556389:SCGB1A1 protein, human; D014598:Uteroglobin