High-frequency oscillatory ventilation combined with intermittent mandatory ventilation in critically ill neonates: 3 years of experience

A heterogeneous group of 45 neonates with severe pulmonary disease and inadequate gas exchange on conventional intermittent mandatory ventilation (IMV) was treated with a high-frequency oscillator combined with an IMV (HFO-IMV) system (Emerson Airway Vibrator connected to a BABYBird 1 ventilator). The mean gestational age was 33 weeks (25.5–43) and mean birth weight 2.02 kg (0.66–4.24). Primary diagnoses included respiratory distress syndrome (RDS; 23), pneumonia (12), persistent fetal circulation (PFC; 6), diaphragmatic hernia/hypoplastic lungs (4). The IMV rate was reduced from 78 to 29 BPM (P0.0005), while maintaining lower partial pressure of carbon dioxide (PaCO₂) (P<0.005) and higher partial pressure of oxygen (PaO₂) (P0.0025). Active air leaks were present in 20 infants and these infants responded most favourably to HFO-IMV. HFO-IMV failed to improve ventilation in neonates with diaphragmatic hernia/hypoplastic lungs. Complications during HFO-IMV were increased pulmonary secretions (11), worsening or recurrence of pre-existing air leaks (11), or occurrence of new air leaks (10). In 4 patients death was related to major air leak complications. Twenty-four infants died, 18 of them of a respiratory cause. Twenty-one infants finally survived. We assembled a well-tolerated system to provide HFO-IMV and to successfully ventilate neonates with severe respiratory disease, who failed to respond to conventional IMV. Initiation of HFO-IMV earlier in the course of the disease in this type of infant may improve survival.Abbreviations BPM breaths per minute - FiO₂ fraction of inspired oxygen - HFI high-frequency flow interrupter - HFJ(V) high-frequency jet (ventilation) - HFO high-frequency oscillation - HFO-IMV high-frequency oscillation combined with intermittent mandatory ventilation - HFPP(V) high-frequency positive pressure (ventilation) - IMV intermittent mandatory ventilation - P(a)CO₂ partial pressure of (arterial) carbon dioxide - P(a)O₂ partial pressure of (arterial) oxygen - Paw mean airway pressure - PFC persistent fetal circulation - PIE pulmonary interstitial emphysema - PIP peak inspiratory pressure - RDS (infant) respiratory distress syndrome