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Hibberd J, Leontini J, Scott T, Pillow JJ, Miedema M, Rimensberger PC, Tingay DG. Neonatal high-frequency oscillatory ventilation: where are we now? Arch Dis Child Fetal Neonatal Ed 2024; 109:467-474. [PMID: 37726160 DOI: 10.1136/archdischild-2023-325657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
High-frequency oscillatory ventilation (HFOV) is an established mode of respiratory support in the neonatal intensive care unit. Large clinical trial data is based on first intention use in preterm infants with acute respiratory distress syndrome. Clinical practice has evolved from this narrow population. HFOV is most often reserved for term and preterm infants with severe, and often complex, respiratory failure not responding to conventional modalities of respiratory support. Thus, optimal, and safe, application of HFOV requires the clinician to adapt mean airway pressure, frequency, inspiratory:expiratory ratio and tidal volume to individual patient needs based on pathophysiology, lung volume state and infant size. This narrative review summarises the status of HFOV in neonatal intensive care units today, the lessons that can be learnt from the past, how to apply HFOV in different neonatal populations and conditions and highlights potential new advances. Specifically, we provide guidance on how to apply an open lung approach to mean airway pressure, selecting the correct frequency and use of volume-targeted HFOV.
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Affiliation(s)
- Jakob Hibberd
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin Leontini
- Department of Mechanical and Product Design Engineering, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Thomas Scott
- Department of Mechanical and Product Design Engineering, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - J Jane Pillow
- School of Human Science, The University of Western Australia, Perth, Western Australia, Australia
- NCCU, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Martijn Miedema
- Neonatology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | | | - David Gerald Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Salvo V, Gazzolo D, Zimmermann LJ. The Complex Interrelationship Between Mechanical Ventilation and Therapeutic Hypothermia in Asphyxiated Newborns. A Review. Ther Hypothermia Temp Manag 2024; 14:80-88. [PMID: 37625025 DOI: 10.1089/ther.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Asphyxiated newborns often require both therapeutic hypothermia (TH) and mechanical ventilation (MV) and the complex interrelationship between these two therapeutic interventions is very interesting, which could not only have several synergistic positive effects but also some risks. Perinatal asphyxia is the leading cause of neonatal hypoxic-ischemic encephalopathy (HIE) and TH is the only approved neuroprotective treatment to limit brain injury, improving the mortality rate and long-term neurological outcomes. HIE is often associated with severe respiratory failure, requiring MV, due to different lung diseases or an impairment of the respiratory drive. The respiratory support management of asphyxiated newborns is very difficult, considering (a) various pathophysiological contexts, (b) the strong impact of TH on gas metabolism and (c) on lung mechanics, and (d) complex TH-MV interactions. Therefore, it is necessary to evaluate the real indications of MV for cooled newborns, considering the risks of respiratory overassistance (hypocapnia/hyperoxia), as well as the adequate monitoring systems. To date, specific randomized studies about the optimal respiratory approach for cooled newborns are lacking, and strategies for MV support vary from center to center. Moreover, there are many open questions about the real effects of cooling on lung mechanics and on surfactant, most appropriate method of blood gas analysis, and clear indications for pharmacological sedation. The aim of this review is to propose a reasoned approach for respiratory management of cooled newborns, considering the pathophysiological context, multiple actions of TH, and consequences of TH-MV matched action and its related risks.
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Affiliation(s)
- Vincenzo Salvo
- Mother and Child Health Department, Neonatal Intensive Care Unit, "Giovanni Paolo II" Hospital of Ragusa, ASP Ragusa, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, "G. D'Annunzio" University, Chieti, Italy
| | - Luc J Zimmermann
- Department of Pediatrics and Neonatology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
- European Foundation for the Care of Newborn Infants (EFCNI), München
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Pérez-Pérez A, González-Pacheco N, Arriaga-Redondo M, Ramos-Navarro C, Rodríguez-Corrales E, de la Blanca ARS, González-Navarro P, Santos-González M, Sánchez-Luna M. Impact on cerebral hemodynamics of the use of volume guarantee combined with high frequency oscillatory ventilation in a neonatal animal respiratory distress model. Eur J Pediatr 2024; 183:157-167. [PMID: 37851085 DOI: 10.1007/s00431-023-05245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
High-frequency oscillatory ventilation (HFOV) is an alternative to conventional mechanical ventilation (CMV). Recently, the use of volume guarantee (VG) combined with HFOV has been suggested as a safe strategy capable of reducing the damage induced by ventilation in immature lungs. However, the possible impact of this new ventilation technique on cerebral hemodynamics is unknown. To evaluate the cerebral hemodynamics effect of HFOV combined with VG in an experimental animal model of neonatal respiratory distress syndrome (RDS) due to surfactant deficiency compared with HFOV and CMV+VG (control group). Eighteen newborn piglets were randomized, before and after the induction of RDS by bronchoalveolar lavage, into 3 mechanical ventilation groups: CMV, HFOV and HFOV with VG. Changes in cerebral oxygen transport and consumption and cerebral blood flow were analyzed by non-invasive regional cerebral oxygen saturation (CrSO2), jugular venous saturation (SjO2), the calculated cerebral oxygen extraction fraction (COEF), the calculated cerebral fractional tissue oxygen extraction (cFTOE) and direct measurement of carotid artery flow. To analyze the temporal evolution of these variables, a mixed-effects linear regression model was constructed. After randomization, the following statistically significant results were found in every group: a drop in carotid artery flow: at a rate of -1.7 mL/kg/min (95% CI: -2.5 to -0.81; p < 0.001), CrSO2: at a rate of -6.2% (95% CI: -7.9 to -4.4; p < 0.001) and SjO2: at a rate of -20% (95% CI: -26 to -15; p < 0.001), accompanied by an increase in COEF: at a rate of 20% (95% CI: 15 to 26; p < 0.001) and cFTOE: at a rate of 0.07 (95% CI: 0.05 to 0.08; p < 0.001) in all groups. No statistically significant differences were found between the HFOV groups. CONCLUSION No differences were observed at cerebral hemodynamic between respiratory assistance in HFOV with and without VG, being the latter ventilatory strategy equally safe. WHAT IS KNOWN • Preterm have a situation of fragility of cerebral perfusion wich means that any mechanical ventilation strategy can have a significant influence. High-frequency oscillatory ventilation (HFOV) is an alternative to conventional mechanical ventilation (CMV). Recently, the use of volume guarantee (VG) combined with HFOV has been suggested as a safe strategy capable of reducing the damage induced by ventilation in immature lungs. Several studies have compared CMV and HFOV and their effects at hemodynamic level. It is known that the use of high mean airway pressure in HFOV can cause an increase in pulmonary vascular resistance with a decrease in thoracic venous return. WHAT IS NEW • The possible impact of VAFO + VG on cerebral hemodynamics is unknown. Due the lack of studies and the existing controversy, we have carried out this research project in an experimental animal model with the aim of evaluating the cerebral hemodynamic repercussion of the use of VG in HFOV compared to the classic strategy without VG.
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Affiliation(s)
- Alba Pérez-Pérez
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain.
| | - Noelia González-Pacheco
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
| | - María Arriaga-Redondo
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
| | - Cristina Ramos-Navarro
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
| | - Elena Rodríguez-Corrales
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
| | | | - Pablo González-Navarro
- Unidad de Investigación Materno Infantil Fundación Familia Alonso (UDIMIFFA) - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Martín Santos-González
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatology Department, Hospital General Universitario Gregorio Marañón, c/ O'Donnell, 48, CP 28009, Madrid, Spain
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王 鲁, 包 志, 马 祎, 牛 利, 陶 鸣. [Therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation on respiratory failure in preterm infants with a gestational age of 28-34 weeks: a prospective randomized controlled study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1101-1106. [PMID: 37990452 PMCID: PMC10672947 DOI: 10.7499/j.issn.1008-8830.2306152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/22/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To investigate the therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation (HFOV-VG) versus conventional mechanical ventilation (CMV) in the treatment of preterm infants with respiratory failure. METHODS A prospective study was conducted on 112 preterm infants with respiratory failure (a gestational age of 28-34 weeks) who were admitted to the Department of Neonatology, Jiangyin Hospital Affiliated to Medical School of Southeast University, from October 2018 to December 2022. The infants were randomly divided into an HFOV-VG group (44 infants) and a CMV group (68 infants) using the coin tossing method based on the mode of mechanical ventilation. The therapeutic efficacy was compared between the two groups. RESULTS After 24 hours of treatment, both the HFOV-VG and CMV groups showed significant improvements in arterial blood pH, partial pressure of oxygen, partial pressure of carbon dioxide, and partial pressure of oxygen/fractional concentration of inspired oxygen ratio (P<0.05), and the HFOV-VG group had better improvements than the CMV group (P<0.05). There were no significant differences between the two groups in the incidence rate of complications, 28-day mortality rate, and length of hospital stay (P>0.05), but the HFOV-VG group had a significantly shorter duration of invasive mechanical ventilation than the CMV group (P<0.05). The follow-up at the corrected age of 6 months showed that there were no significant differences between the two groups in the scores of developmental quotient, gross motor function, fine motor function, adaptive ability, language, and social behavior in the Pediatric Neuropsychological Development Scale (P>0.05). CONCLUSIONS Compared with CMV mode, HFOV-VG mode improves partial pressure of oxygen and promotes carbon dioxide elimination, thereby enhancing oxygenation and shortening the duration of mechanical ventilation in preterm infants with respiratory failure, while it has no significant impact on short-term neurobehavioral development in these infants.
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Solís-García G, Ramos-Navarro C, González-Pacheco N, Sánchez-Luna M. Lung protection strategy with high-frequency oscillatory ventilation improves respiratory outcomes at two years in preterm respiratory distress syndrome: a before and after, quality improvement study. J Matern Fetal Neonatal Med 2022; 35:10698-10705. [PMID: 36521851 DOI: 10.1080/14767058.2022.2155040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) remains one of the major challenges of extreme prematurity. High-frequency oscillatory ventilation (HFOV) with volume guarantee (HFOV-VG) can be used as an early-rescue ventilation to protect developing lungs. However, the studies exploring the impact of this ventilatory strategy on neonatal respiratory morbidity are very limited. This study aimed at documenting the improvement in respiratory outcomes in mechanically ventilated preterm newborns, after the implementation of a new mechanical ventilation respiratory bundle. METHODS A prospective, quality improvement study was conducted between January 2012 and December 2018 in a third level NICU in Madrid, Spain. Infants born <32 weeks of gestation with severe respiratory distress syndrome (RDS) and requiring invasive mechanical ventilation were included. The intervention consisted of a new ventilation respiratory care bundle, with HFOV as early rescue therapy using low high-frequency tidal volumes (Vthf) and higher frequencies (15-20 Hz). Criteria for HFOV start were impaired oxygenation or ventilation on conventional ventilation, or peak inspiratory pressures >15 cmH2O. Two cohorts of mechanically ventilated patients were compared, cohort 1 (2012-2013, baseline period) and cohort 2 (2016-2018, after implementation of the new bundle). Clinical outcomes at 36 weeks and 2 years of postmenstrual age were compared between the groups. RESULTS A total of 216 patients were included, the median gestational age was 26 weeks (IQR 25-28) and median birth weight was 895 g (IQR 720-1160). There were no significant differences in survival between the groups, but patients with the protective ventilation strategy (cohort 2) had higher survival without BPD 2-3 (OR 2.93, 95%CI 1.41-6.05). At 2 years of postmenstrual age, patients in cohort 2 also had a higher survival free of baseline respiratory treatment and hospital respiratory admissions than the control group (adjusted OR 2.33, 95%CI 1.10-4.93, p=.03). The results did not suggest significant differences in neurologic development. CONCLUSIONS In extreme premature related severe respiratory failure, the use of a lung protective HFOV-VG strategy was proven to be a useful quality improvement intervention in our unit, leading to better pulmonary outcomes at 36 weeks and additional improved respiratory prognosis at two years of age.
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Affiliation(s)
- Gonzalo Solís-García
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Neonatology Division, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Cristina Ramos-Navarro
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Noelia González-Pacheco
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Solis-Garcia G, González-Pacheco N, Ramos-Navarro C, Vigil-Vázquez S, Gutiérrez-Vélez A, Merino-Hernández A, Rodríguez Sánchez De la Blanca A, Sánchez-Luna M. Lung recruitment in neonatal high-frequency oscillatory ventilation with volume-guarantee. Pediatr Pulmonol 2022; 57:3000-3008. [PMID: 35996817 DOI: 10.1002/ppul.26124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 08/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES The optimal lung volume strategy during high-frequency oscillatory ventilation (HFOV) is reached by performing recruitment maneuvers, usually guided by the response in oxygenation. In animal models, secondary spontaneous change in oscillation pressure amplitude (ΔPhf) associated with a progressive increase in mean airway pressure during HFOV combined with volume guarantee (HFOV-VG) identifies optimal lung recruitment. The aim of this study was to describe recruitment maneuvers in HFOV-VG and analyze whether changes in ΔPhf might be an early predictor for lung recruitment in newborn infants with severe respiratory failure. DESIGN AND METHODS The prospective observational study was done in a tertiary-level neonatology department. Changes in ΔPhf were analyzed during standardized lung recruitment after initiating early rescue HFOV-VG in preterm infants with severe respiratory failure. RESULTS Twenty-seven patients were included, with a median gestational age of 24 weeks (interquartile range [IQR]: 23-25). Recruitment maneuvers were performed, median baseline mean airway pressure (mPaw) was 11 cm H2 O (IQR: 10-13), median critical lung opening mPaw during recruitment was 14 cm H2 O (IRQ: 12-16), and median optimal mPaw was 12 cm H2 O (IQR: 10-14, p < 0.01). Recruitment maneuvers were associated with an improvement in oxygenation (FiO2 : 65.0 vs. 45.0, p < 0.01, SpO2/FiO2 ratio: 117 vs. 217, p < 0.01). ΔPhf decreased significantly after lung recruitment (mean amplitude: 23.0 vs. 16.0, p < 0.01). CONCLUSION In preterm infants with severe respiratory failure, the lung recruitment process can be effectively guided by ΔPhf on HFOV-VG.
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Affiliation(s)
- Gonzalo Solis-Garcia
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,The Hospital for Sick Children, Toronto, Canada
| | - Noelia González-Pacheco
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Ramos-Navarro
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Sara Vigil-Vázquez
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Gutiérrez-Vélez
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Amaia Merino-Hernández
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | | | - Manuel Sánchez-Luna
- Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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High-frequency ventilation in preterm infants and neonates. Pediatr Res 2022:10.1038/s41390-021-01639-8. [PMID: 35136198 DOI: 10.1038/s41390-021-01639-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/08/2022]
Abstract
High-frequency ventilation (HFV) has been used as a respiratory support mode for neonates for over 30 years. HFV is characterized by delivering tidal volumes close to or less than the anatomical dead space. Both animal and clinical studies have shown that HFV can effectively restore lung function, and potentially limit ventilator-induced lung injury, which is considered an important risk factor for developing bronchopulmonary dysplasia (BPD). Knowledge of how HFV works, how it influences cardiorespiratory physiology, and how to apply it in daily clinical practice has proven to be essential for its optimal and safe use. We will present important aspects of gas exchange, lung-protective concepts, clinical use, and possible adverse effects of HFV. We also discuss the study results on the use of HFV in respiratory distress syndrome in preterm infants and respiratory failure in term neonates. IMPACT: Knowledge of how HFV works, how it influences cardiorespiratory physiology, and how to apply it in daily clinical practice has proven to be essential for its optimal and safe use. Therefore, we present important aspects of gas exchange, lung-protective concepts, clinical use, and possible adverse effects of HFV. The use of HFV in daily clinical practice in lung recruitment, determination of the optimal continuous distending pressure and frequency, and typical side effects of HFV are discussed. We also present study results on the use of HFV in respiratory distress syndrome in preterm infants and respiratory failure in term neonates.
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Abstract
High-frequency ventilation (HFV) is an alternative to conventional mechanical ventilation, with theoretic benefits of less risk of ventilator lung injury and more effectivity in washout CO2. Previous clinical studies have not demonstrated advantages of HFV in preterm infants compared with conventional ventilation, so rescue HFV has been used when severe respiratory insufficiency needs aggressive ventilator settings in immature infants. Today it is possible to measure, set directly, and fix tidal volume, which can protect the immature lung from large volumes and fluctuations of the tidal volume. This strategy can be used in preterm infants with respiratory failure needing invasive ventilation.
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Zheng YR, Xie WP, Liu JF, Wu HL, Xu N, Huang ST, Cao H, Chen Q. Impact of High-Frequency Oscillatory Ventilation Combined With Volume Guarantee on Lung Inflammatory Response in Infants With Acute Respiratory Distress Syndrome After Congenital Heart Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2021; 36:2368-2375. [PMID: 34753654 DOI: 10.1053/j.jvca.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Congenital heart disease (CHD) after cardiopulmonary bypass can cause systemic inflammation, and its degree is closely related to the incidence of acute respiratory distress syndrome (ARDS). The purpose of this study was to determine the effectiveness of high-frequency oscillatory ventilation (HFOV) combined with volume guarantee (VG) in reducing systemic inflammation in infants with ARDS after cardiopulmonary bypass for congenital heart surgery. DESIGN A randomized controlled trial. SETTING Single-center study in a tertiary teaching hospital. PARTICIPANTS A total of 58 infants with ARDS after congenital heart surgery were eligible and were randomized to the HFOV (n = 29) or the HFOV-VG (n = 29) between January 2020 and January 2021. INTERVENTIONS Tracheal aspirate samples for the measurement of interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) were obtained on days one, two, and three of HFOV or HFOV-VG ventilation. MEASUREMENTS AND MAIN RESULTS The authors found a significantly increasing trend in the HFOV group mean values of IL-6, IL-8, and TNF-α (p < 0.05 on days two and three v day one), and IL-6, IL-8, and TNF-α levels were significantly higher on day three in the HFOV group versus the HFOV+VG group (p < 0.05). In addition, the incidences of hypocapnia and hypercapnia in infants supported with HFOV-VG were significantly lower (p < 0.05). Furthermore, the postoperative mechanical ventilation duration in the HFOV-VG group also was shorter than that in the HFOV group (p < 0.05). CONCLUSION Compared with HFOV alone, HFOV-VG reduced proinflammatory systemic reactions after congenital cardiac surgery, decreased the incidences of hypercapnia and hypocapnia, and shortened the postoperative mechanical ventilation duration.
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Affiliation(s)
- Yi-Rong Zheng
- Department of Cardiac Surgery, Fujian branch of Shanghai Children's Medical Center, Fuzhou, China; Fujian Children's Hospital, Fuzhou, China; Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Peng Xie
- Department of Cardiac Surgery, Fujian branch of Shanghai Children's Medical Center, Fuzhou, China; Fujian Children's Hospital, Fuzhou, China; Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian branch of Shanghai Children's Medical Center, Fuzhou, China; Fujian Children's Hospital, Fuzhou, China; Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hong-Lin Wu
- Department of Cardiac Surgery, Fujian branch of Shanghai Children's Medical Center, Fuzhou, China; Fujian Children's Hospital, Fuzhou, China; Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian branch of Shanghai Children's Medical Center, Fuzhou, China; Fujian Children's Hospital, Fuzhou, China; Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian branch of Shanghai Children's Medical Center, Fuzhou, China; Fujian Children's Hospital, Fuzhou, China; Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian branch of Shanghai Children's Medical Center, Fuzhou, China; Fujian Children's Hospital, Fuzhou, China; Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian branch of Shanghai Children's Medical Center, Fuzhou, China; Fujian Children's Hospital, Fuzhou, China; Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.
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Solís-García G, González-Pacheco N, Ramos-Navarro C, Rodríguez Sánchez de la Blanca A, Sánchez-Luna M. Target volume-guarantee in high-frequency oscillatory ventilation for preterm respiratory distress syndrome: Low volumes and high frequencies lead to adequate ventilation. Pediatr Pulmonol 2021; 56:2597-2603. [PMID: 34107176 DOI: 10.1002/ppul.25529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Respiratory distress syndrome (RDS) and ventilation-induced lung injury lead to significant morbidity in preterm infants. High-frequency oscillatory ventilation with volume-guarantee (HFOV-VG) has been used as a rescue therapy and might lead to lower rates of death and bronchopulmonary dysplasia, especially when using low tidal volumes and high frequencies. The aim of the study was to define HFOV-VG parameters leading to adequate ventilation in the first 72 h of preterm RDS using a low volume and high-frequency strategy. DESIGN AND METHODS Retrospective cohort study in a tertiary-level neonatology unit. Infants <32 weeks with severe respiratory insufficiency needing HFOV-VG were included. Patients were ventilated following a standard mechanical ventilation aiming for low tidal volumes and high frequencies. Clinical data, perinatal characteristics and high-frequency parameters corresponding with adequate ventilation were recorded. RESULTS 116 patients were included. Median gestational age was 25 weeks (interquartile range [IQR] = 24-27), median birth weight 724 g (IQR = 600-900 g). HFOV-VG was started at 2 h, median high-frequency tidal volume was 1.63 ml/kg (IQR = 1.44-1.84) and median frequency was 16 Hz (IQR = 15-18). Weight-adjusted tidal volumes did not depend on gestational age, antenatal corticosteroids nor chorioamnionitis, and were inversely correlated with frequencies (R 2 = -0.10, p = .001). CONCLUSION HFOV-VG can reach adequate ventilation at high frequencies when using adequate volumes, providing a feasible ventilation strategy that might be of help in preterm infants with RDS.
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Affiliation(s)
- Gonzalo Solís-García
- Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Manuel Sánchez-Luna
- Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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11
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Zheng YR, Xie WP, Liu JF, Wu HL, Xu N, Huang ST, Cao H, Chen Q. Application of high-frequency oscillation ventilation combined with volume guarantee in infants with acute hypoxic respiratory failure after congenital heart surgery. Pediatr Pulmonol 2021; 56:2621-2626. [PMID: 33964188 DOI: 10.1002/ppul.25447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of high-frequency oscillation ventilation combined with volume guarantee (HFOV-VG) compared with the safety and efficacy of HFOV alone in infants with acute hypoxemic respiratory failure (AHRF) after congenital heart surgery. METHODS We retrospectively analyzed the clinical data of 44 infants who were ventilated for AHRF after congenital heart surgery between January 2020 and January 2021. HFOV alone was used in 23 of the 44 infants, whereas HFOV-VG was used in the other 21 infants. RESULTS The average frequency tidal volume (VThf) of the HFOV-VG group was lower than that of the HFOV group, and the proportion of VThf exceeding the target range of infants in the HFOV-VG group was also lower (p < .01). In addition, the incidence of hypocapnia and hypercapnia in infants supported with HFOV-VG was significantly lower (p < .01). Furthermore, the duration of invasive ventilation and the median ventilator adjustment per hour in the HFOV-VG group was also lower than that in the HFOV group (p < .01). CONCLUSIONS Compared with HFOV alone, HFOV-VG decreases the fluctuation of VThf and the incidence of hypercapnia and hypocapnia. Moreover, it reduces the workload of bedside medical staff. Further studies are needed to confirm the efficacy and safety of HFOV-VG as a routine respiratory support strategy for congenital heart disease during the perioperative period.
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Affiliation(s)
- Yi-Rong Zheng
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Hong-Lin Wu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
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12
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Tana M, Paladini A, Tirone C, Aurilia C, Lio A, Bottoni A, Costa S, Tiberi E, Pastorino R, Vento G. Effects of High-Frequency Oscillatory Ventilation With Volume Guarantee During Surfactant Treatment in Extremely Low Gestational Age Newborns With Respiratory Distress Syndrome: An Observational Study. Front Pediatr 2021; 9:804807. [PMID: 35310140 PMCID: PMC8927884 DOI: 10.3389/fped.2021.804807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the effect of volume guarantee (VG) combined with high-frequency oscillatory ventilation (HFOV) on respiratory and other physiological parameters immediately after lung recruitment and surfactant administration in HFOV elective ventilated extremely low gestational age newborns (ELGAN) with respiratory distress syndrome (RDS). DESIGN Observational study. SETTING Tertiary neonatal intensive care unit. PATIENTS Twenty-two ELGANs of 25.5 ± 1.1 weeks of gestational age requiring invasive mechanical ventilation and surfactant administration for RDS during the first 6 h of life. INTERVENTIONS All infants intubated in delivery room, were managed with elective HFOV and received surfactant after a lung recruitment manoeuver. Eleven infants received HFOV + VG and were compared with a control group of 11 infants receiving HFOV alone. HFOV was delivered in both groups by Dräger Babylog VN500 ventilator (Dräger, Lubeck, Germany). MAIN OUTCOME MEASURES Variations and fluctuations of delivered high-frequency tidal volume (VThf), fluctuation of pressure amplitude (ΔP) and partial pressure of CO2 (pCO2) levels after recruitment manoeuver and immediately after surfactant administration, in HFOV + VG vs. HFOV ventilated infants. RESULTS There were no significant differences in the two groups at starting ventilation with or without VG. The mean applied VThf per kg was 1.7 ± 0.3 ml/kg in the HFOV group and 1.7 ± 0.1 ml/kg in the HFOV + VG group. Thirty minutes after surfactant administration, HFOV group had a significant higher VThf/Kg than HFOV + VG (2.1 ± 0.3 vs. 1.6 ± 0.1 ml/kg, p < 0.0001) with significantly lower pCO2 levels (43.1 ± 3.8 vs. 46.8 ± 1.5 mmHg, p = 0.01), 54.4% of patients having pCO2 below 45 mmHg. Measured post-surfactant ΔP values were higher in HFOV group (17 ± 3 cmH2O) than in HFOV + VG group (13 ± 3 cmH2O, p = 0.01). CONCLUSION HFOV + VG maintains pCO2 levels within target range and reduces VThf delivered variations more consistently than HFOV alone after surfactant administration.
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Affiliation(s)
- Milena Tana
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angela Paladini
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Tirone
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Aurilia
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Lio
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anthea Bottoni
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simonetta Costa
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eloisa Tiberi
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Vento
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Rodríguez Sánchez de la Blanca A, Sánchez Luna M, González Pacheco N, Ramos Navarro C, Santos González M, Tendillo Cortijo F. New indicators for optimal lung recruitment during high frequency oscillator ventilation. Pediatr Pulmonol 2020; 55:3525-3531. [PMID: 32965770 DOI: 10.1002/ppul.25084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 08/26/2020] [Accepted: 09/15/2020] [Indexed: 11/09/2022]
Abstract
UNLABELLED Previous research has demonstrated the potential benefit derived from the combination of high frequency oscillatory ventilation and volume guarantee mode (HFOV-VG), a procedure that allows us to explore and control very low tidal volumes. We hypothesized that secondary spontaneous change in oscillation pressure amplitude (∆Phf), while increasing the mean airway pressure (MAP) using HFOV-VG can target the lung recruitment. METHODS A two-step animal distress model study was designed; in the first-step (ex vivo model), the animal's lungs were isolated to visually check lung recruitment and, in the second one (in vivo model), they were checked through arterial oxygen partial pressure improvement. Baseline measurements were performed, ventilation was set for 10 min and followed by bronchoalveolar lavage with isotonic saline to induce depletion of surfactant and thereby achieve a low compliance lung model. The high-frequency tidal volume and frequency remained constant and the MAP was increased by 2 cmH2 O (ex vivo) and 3 cmH2 O steps (in vivo) every 2 min. Changes in ΔPhf to achieve the fixed volume were recorded at the end of each interval to describe the maximum drop point as the recruitment point. RESULTS Fourteen Wistar Han rats were included, seven on each sub-study described. After gradual MAP increments, a progressive decrease in ΔPhf related to recruited lung regions was visually demonstrated. In the in vivo model we detected a significant comparative decrease of ΔPhf, when measured against the previous value, after reaching a MAP of 11 cmH2 O up to 17 cmH2 O, correlating with a significant improvement in oxygenation. CONCLUSION The changes in ∆Phf, linked to a progressive increase in MAP during HFOV-VG, might identify optimal lung recruitment and could potentially be used as an additional lung recruitment marker.
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Affiliation(s)
| | - Manuel Sánchez Luna
- Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Martín Santos González
- Medical and Surgical Research Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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14
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González-Pacheco N, Sánchez-Luna M, Arribas-Sánchez C, Santos-González M, Orden-Quinto C, Tendillo-Cortijo F. DCO 2/PaCO 2 correlation on high-frequency oscillatory ventilation combined with volume guarantee using increasing frequencies in an animal model. Eur J Pediatr 2020; 179:499-506. [PMID: 31823075 DOI: 10.1007/s00431-019-03503-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/12/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
To examine the correlation DCO2/PaCO2 on high-frequency oscillatory ventilation (HFOV) combined with volume guarantee (VG) throughout increasing frequencies in two different respiratory conditions, physiological and low compliance. Neonatal animal model was used, before and after a bronchoalveolar lavage (BAL). HFOV combined with VG was used. The frequency was increased from 10 to 20 Hz, and high-frequency tidal volume (VThf) was gradually decreased maintaining a constant DCO2. Arterial partial pressure of carbon dioxide (PaCO2) was evaluated after each frequency and VThf change. Six 2-day-old piglets were studied. A linear decrease in PaCO2 was observed throughout increasing frequencies in both respiratory conditions while maintaining a constant DCO2, showing a significant difference between the initial PaCO2 (at 10 Hz) and the PaCO2 obtained at 18 and 20 Hz. A new DCO2 equation (corrected DCO2) was calculated in order to better define the correlation between DCO2 and the observed PaCO2.Conclusion: The correlation DCO2/PaCO2 throughout increasing frequencies is not linear, showing a greater CO2 elimination efficiency at higher frequencies, in spite of maintaining a constant DCO2. So, using frequencies close to the resonant frequency of the respiratory system on HFOV combined with VG, optimizes the efficiency of gas exchange.What is Known: • The efficacy of CO2removal during high-frequency oscillatory ventilation (HFOV), described as the diffusion coefficient of CO2(DCO2) is related to the square of the high-frequency tidal volume (VThf) and the frequency (f), expressed as DCO2= VThf2× f.What is New: • The correlation between DCO2and PaCO2throughout increasing frequencies is not linear, showing a greater CO2elimination efficiency at higher frequencies. So, using very high frequencies on HFOV combined with volume guarantee optimizes the efficiency of gas exchange allowing to minimize lung injury.
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Affiliation(s)
- Noelia González-Pacheco
- Neonatology Division, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Hospital General Universitario "Gregorio Marañón", C/Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Manuel Sánchez-Luna
- Neonatology Division, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Hospital General Universitario "Gregorio Marañón", C/Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Cristina Arribas-Sánchez
- Neonatology Division, Clínica Universidad de Navarra, C/Marquesado de Sta. Marta, 1, 28027, Madrid, Spain
| | - Martín Santos-González
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Spain
| | - Cristina Orden-Quinto
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Spain
| | - Francisco Tendillo-Cortijo
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Spain
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15
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Tuzun F, Deliloglu B, Cengiz MM, Iscan B, Duman N, Ozkan H. Volume Guarantee High-Frequency Oscillatory Ventilation in Preterm Infants With RDS: Tidal Volume and DCO 2 Levels for Optimal Ventilation Using Open-Lung Strategies. Front Pediatr 2020; 8:105. [PMID: 32266185 PMCID: PMC7105735 DOI: 10.3389/fped.2020.00105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/28/2020] [Indexed: 11/19/2022] Open
Abstract
High frequency oscillatory ventilation with volume-guarantee (HFOV-VG) is a promising lung protective ventilator mode for the treatment of respiratory failure in newborns. However, indicators of optimal ventilation during HFOV-VG mode are not identified yet. In this study, we aimed to evaluate optimal high-frequency tidal volume (VThf) and the dissociation coefficient of CO2 (DCO2) levels to achieve normocapnia during HFOV-VG after lung recruitment in very low birthweight infants with respiratory distress syndrome (RDS). Preterm babies under the 32nd postmenstrual week with severe RDS that received HFOV-VG using open-lung strategy between January 2014 and January 2019 were retrospectively evaluated. All included patients were treated with the Dräger Babylog VN500 ventilator in the HFOV-VG mode. In total, 53 infants with a mean gestational age of 26.8 ± 2.3 weeks were evaluated. HFOV mean optimal airway pressure (MAPhf) level after lung recruitment was found to be 10.2 ± 1.7 mbar. Overall, the mean applied VThf per kg was 1.64 ± 0.25 mL/kg in the study sample. To provide normocapnia, the mean VThf was 1.61 ± 0.25 mL/kg and the mean DCO2corr was 29.84 ± 7.88 [mL/kg]2/s. No significant correlation was found between pCO2 levels with VThf (per kg) or DCO2corr levels. VThf levels to maintain normocarbia were significantly lower with 12 Hz frequency compared to 10 Hz frequency (1.50 ± 0.24 vs. 1.65 ± 0.25 mL/ kg, p < 0.001, respectively). A weak but significant positive correlation was found between mean airway pressure (MAPhf) and VThf levels. To our knowledge, this is the largest study to evaluate the optimal HFOV-VG settings in premature infants with RDS, using the open-lung strategy. According to the results, a specific set of numbers could not be recommended to achieve normocarbia. Following the trend of each patient and small adjustments according to the closely monitored pCO2 levels seems logical.
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Affiliation(s)
- Funda Tuzun
- Division of Neonatology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Burak Deliloglu
- Division of Neonatology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Merve Meryem Cengiz
- Division of Neonatology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Burcin Iscan
- Division of Neonatology, Department of Pediatrics, Tinaztepe University Faculty of Medicine, Izmir, Turkey
| | - Nuray Duman
- Division of Neonatology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Hasan Ozkan
- Division of Neonatology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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16
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Effect of a new respiratory care bundle on bronchopulmonary dysplasia in preterm neonates. Eur J Pediatr 2020; 179:1833-1842. [PMID: 32488737 PMCID: PMC7266384 DOI: 10.1007/s00431-020-03694-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 02/03/2023]
Abstract
The development of devices that can fix the tidal volume in high-frequency oscillatory ventilation (HFOV) has allowed for a significant improvement in the management of HFOV. At our institution, this had led to the earlier use of HFOV and promoted a change in the treatment strategy involving the use of higher frequencies (above 15 Hz) and lower high-frequency tidal volumes (VThf). The purpose of this observational study was to assess how survival without bronchopulmonary dysplasia grades 2 and 3 (SF-BPD) is influenced by these modifications in the respiratory strategy applied to preterm infants (gestational age < 32 weeks at birth) who required mechanical ventilation (MV) in the first 3 days of life. We compared a baseline period (2012-2013) against a period in which this strategy had been fully implemented (2016-2017). A total of 182 patients were exposed to MV in the first 3 days of life being a higher proportion on HFOV at day 3 in the second period 79.5% (n 35) in 2016-2017 vs 55.4% (n 31) in 2012-2013. After adjusting for perinatal risk factors, the second period is associated with an increased rate of SF-BPD (OR 2.28; CI 95% 1.072-4.878); this effect is more evident in neonates born at a gestational age of less than 29 weeks (OR 4.87; 95% CI 1.9-12.48).Conclusions : The early use of HFOV combined with the use of higher frequencies and very low VT was associated with an increase in the study population's SF-BPD. What is Known: • High-frequency ventilation with volume guarantee improve ventilation stability and has been shown to reduce lung damage in animal models. What is New: • The strategy of an earlier use of high-frequency oscillatory ventilation combined with the use of higher frequencies and lower tidal volume is associated to an increase in survival without bronchopulmonary dysplasia in our population of preterm infants.
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17
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Chen LJ, Chen JY. Effect of high-frequency oscillatory ventilation combined with volume guarantee on preterm infants with hypoxic respiratory failure. J Chin Med Assoc 2019; 82:861-864. [PMID: 31693534 DOI: 10.1097/jcma.0000000000000146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the effect of volume guarantee (VG) on high-frequency oscillatory ventilation (HFOV) compared with HFOV alone in preterm infants with hypoxic respiratory failure (HRF). METHODS Fifty-two preterm infants with HRF refractory to conventional mechanical ventilation (CMV) were enrolled in this study. Between June 2012 and February 2016, HFOV alone was used as rescue therapy when CMV failed for 34 infants, whereas HFOV combined with VG was used as rescue therapy for the other 18 infants between March 2016 and December 2017. RESULTS HFOV combined with VG resulted in a reduction in the combined outcome of death or bronchopulmonary dysplasia (BPD) (p = 0.017) and also a reduction in episodes of hypercarbia (p = 0.010) compared with HFOV alone. CONCLUSION In this study, the preterm infants with HRF ventilated using HFOV combined with VG had a reduced combined outcome of death or BPD and hypercarbia compared with those who received HFOV alone.
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Affiliation(s)
- Lih-Ju Chen
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Jia-Yuh Chen
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
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18
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Use of very low tidal volumes during high-frequency ventilation reduces ventilator lung injury. J Perinatol 2019; 39:730-736. [PMID: 30770883 DOI: 10.1038/s41372-019-0338-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/13/2018] [Accepted: 01/28/2019] [Indexed: 11/08/2022]
Abstract
UNLABELLED The use of volume guarantee (VG) on high-frequency oscillatory ventilation (HFOV) allows to use fixed very low high-frequency tidal volume (VThf), maintaining adequate CO2 removal while potentially reducing the risk of ventilator-induced lung injury. OBJECTIVE To demonstrate that the use of very low VThf can be protective compared with standard VThf on HFOV combined with VG in a neonatal animal model. STUDY DESIGN Experimental study in 2-day-old piglets with induced respiratory distress syndrome ventilated with two different HFOV strategies combined with VG (10 Hz with high VThf versus 20 Hz with very low VThf at similar PaCO2). After 12 h of mechanical ventilation, the pulmonary histologic pattern was analyzed. RESULTS We found in the 10 Hz group with the higher VThf compared with the 20 Hz and very low VThf group more evident and more severe histological lesions with inflammatory infiltrate within the alveolar wall and alveolar space, as well as large areas of parenchyma consolidation and areas of alveolar hemorrhage in the more severe cases. CONCLUSION The use of very low VThf compared with higher VThf at similar CO2 removal reduces lung injury in a neonatal animal model of lung injury after prolonged mechanical ventilation with HFOV combined with VG.
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Lee SM, Namgung R, Eun HS, Lee SM, Park MS, Park KI. Effective Tidal Volume for Normocapnia in Very-Low-Birth-Weight Infants Using High-Frequency Oscillatory Ventilation. Yonsei Med J 2018; 59:101-106. [PMID: 29214783 PMCID: PMC5725345 DOI: 10.3349/ymj.2018.59.1.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Removal of CO₂ is much efficient during high-frequency oscillatory ventilation (HFOV) for preterm infants. However, an optimal carbon dioxide diffusion coefficient (DCO₂) and tidal volume (VT) have not yet been established due to much individual variance. This study aimed to analyze DCO₂ values, VT, and minute volume in very-low-birth-weight (VLBW) infants using HFOV and correlates with plasma CO₂ (pCO₂). MATERIALS AND METHODS Daily respiratory mechanics and ventilator settings from twenty VLBW infants and their two hundred seventeen results of blood gas analysis were collected. Patients were treated with the Dräger Babylog VN500 ventilator (Drägerwerk Ag & Co.) in HFOV mode. The normocapnia was indicated as pCO₂ ranging from 45 mm Hg to 55 mm Hg. RESULTS The measured VT was 1.7 mL/kg, minute volume was 0.7 mL/kg, and DCO₂ was 43.5 mL²/s. Mean results of the blood gas test were as follows: pH, 7.31; pCO₂, 52.6 mm Hg; and SpO₂, 90.5%. In normocapnic state, the mean VT was significantly higher than in hypercapnic state (2.1±0.5 mL/kg vs. 1.6±0.3 mL/kg), and the mean DCO₂ showed significant difference (68.4±32.7 mL²/s vs. 32.4±15.7 mL²/s). The DCO₂ was significantly correlated with the pCO₂ (p=0.024). In the receiver operating curve analysis, the estimated optimal cut-off point to predict the remaining normocapnic status was a VT of 1.75 mL/kg (sensitivity 73%, specificity 80%). CONCLUSION In VLBW infants treated with HFOV, VT of 1.75 mL/kg is recommended for maintaining proper ventilation.
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Affiliation(s)
- Seul Mi Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sun Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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20
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Zannin E, Dellaca' RL, Dognini G, Marconi L, Perego M, Pillow JJ, Tagliabue PE, Ventura ML. Effect of frequency on pressure cost of ventilation and gas exchange in newborns receiving high-frequency oscillatory ventilation. Pediatr Res 2017; 82:994-999. [PMID: 28665929 DOI: 10.1038/pr.2017.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/09/2017] [Indexed: 11/09/2022]
Abstract
BackgroundWe hypothesized that ventilating at the resonant frequency of the respiratory system optimizes gas exchange while limiting the mechanical stress to the lung in newborns receiving high-frequency oscillatory ventilation (HFOV). We characterized the frequency dependence of oscillatory mechanics, gas exchange, and pressure transmission during HFOV.MethodsWe studied 13 newborn infants with a median (interquartile range) gestational age of 29.3 (26.4-30.4) weeks and body weight of 1.00 (0.84-1.43) kg. Different frequencies (5, 8, 10, 12, and 15 Hz) were tested, keeping carbon dioxide diffusion coefficient (DCO2) constant. Oscillatory mechanics and transcutaneous blood gas were measured at each frequency. The attenuation of pressure swings (ΔP) from the airways opening to the distal end of the tracheal tube (TT) and to the alveolar compartment was mathematically estimated.ResultsBlood gases were unaffected by frequency. The mean (SD) resonant frequency was 16.6 (3.5) Hz. Damping of ΔP increased with frequency and with lung compliance. ΔP at the distal end of the TT was insensitive to frequency, whereas ΔP at the peripheral level decreased with frequency.ConclusionThere is no optimal frequency for gas exchange when DCO2 is held constant. Greater attenuation of oscillatory pressure at higher frequencies offers more protection from barotrauma, especially in patients with poor compliance.
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Affiliation(s)
- Emanuela Zannin
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di, Milano University, Milan, Italy
| | - Raffaele L Dellaca'
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di, Milano University, Milan, Italy
| | - Giulia Dognini
- Obstetric and Pediatric Department, Neonatal Intensive Care Unit, Fondazione MBBM-ASST, Monza, Italy
| | - Lara Marconi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di, Milano University, Milan, Italy
| | - Martina Perego
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di, Milano University, Milan, Italy
| | - Jane J Pillow
- Centre for Neonatal Research and Education, School of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
| | - Paolo E Tagliabue
- Obstetric and Pediatric Department, Neonatal Intensive Care Unit, Fondazione MBBM-ASST, Monza, Italy
| | - Maria Luisa Ventura
- Obstetric and Pediatric Department, Neonatal Intensive Care Unit, Fondazione MBBM-ASST, Monza, Italy
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Belteki G, Lin B, Morley CJ. Weight-correction of carbon dioxide diffusion coefficient (DCO 2 ) reduces its inter-individual variability and improves its correlation with blood carbon dioxide levels in neonates receiving high-frequency oscillatory ventilation. Pediatr Pulmonol 2017; 52:1316-1322. [PMID: 28682001 DOI: 10.1002/ppul.23759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 06/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Carbon-dioxide elimination during high-frequency oscillatory ventilation (HFOV) is thought to be proportional to the carbon dioxide diffusion coefficient (DCO2 ) which is calculated as frequency x (tidal volume)2 . DCO2 can be used to as an indicator of CO2 elimination but values obtained in different patients cannot be directly compared. OBJECTIVES To analyze the relationship between DCO2 , the weight-corrected DCO2 (DCO2 corr) and blood gas PCO2 values obtained from infants receiving HFOV. METHODS DCO2 data were obtained from 14 infants at 1/s sampling rate and the mean DCO2 was determined over 10 min periods preceding the time of the blood gas. DCO2 corr was calculated by dividing the DCO2 by the square of the body weight in kg. RESULTS Weight-correction significantly reduced the inter-individual variability of DCO2 . When data from all the babies were combined, standard DCO2 showed no correlation with PCO2 but DCO2 corr showed a weak but statistically significant inverse correlation. The correlation was better when the endotracheal leak was <10%. There was significant inverse but weaker correlation between the HFOV tidal volume (VThf) and the PCO2 . In any baby, DCO2 corr >50 mL2 /sec/kg2 or VThf > 2.5 mL/kg was rarely needed to avoid hypercapnia. CONCLUSIONS Weight-correction of DCO2 values improved its comparability between patients. Weight-corrected DCO2 correlated better with PCO2 than uncorrected DCO2 but the correlation was weak.
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Affiliation(s)
- Gusztav Belteki
- Department of Neonatology, The Rosie Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Benjamin Lin
- Department of Neonatology, The Rosie Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Colin J Morley
- Department of Neonatology, The Rosie Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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Targeting supernormal frequencies and very low tidal volumes in high-frequency oscillatory ventilation: can 'volume guarantee' deliver? J Perinatol 2016; 36:794. [PMID: 27562183 DOI: 10.1038/jp.2016.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Response to "Targeting supernormal frequencies and very low tidal volumes in high-frequency oscillatory ventilation: can 'volume guarantee' deliver?". J Perinatol 2016; 36:795. [PMID: 27562184 DOI: 10.1038/jp.2016.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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