Objective: To evaluate clinical effectiveness of high frequency oscillatory ventilation (HFOV) with a high-volume strategy in severe neonatal respiratory failure from different causes.
Patients and methods: Infants with respiratory failure with oxygenation index (O.I.) > 10, independently from weight, gestation age, kind of respiratory disease, previous treatment with conventional mechanical ventilation (IPPV). Patients were treated with respirator Sensormedics 3100 A. Values of O.I. were recorded at start of HFOV and after 1/2, 6 and 24 hours. Also blood gases, arterial blood pressure and vital data were monitored. If HFOV failed infants were allowed to be shifted to IPPV.
Results: 10 infants were selected whose gestation age was comprised between 25-38 weeks and birth weight between 640-2620 grams. Mean value of O.I. at the beginning of HFOV was 31.5 +/- 25.1. In all cases but one O.I. decreased rapidly after HFOV and improvement was significant after 6 hours (10.7 +/- 6.3; p < 0.003) still improving after 24 hours (9.5 +/- 5; p < 0.002). The neonate that did not respond to HFOV had severe congenital valvular aortic stenosis and weighted 930 grams. Four infants died: 3 after response of respiratory failure to HFOV and 1 for cardiopathy. Side-effects were: i) edema in all infants that was treated with furosemide, and ii) transient decrease of sistemic blood pressure after start of HFOV in 6 infants that was treated easily with low-dosage dopamine infusion. No significant increase of the rate of complicating disease was observed in survived patients.
Conclusion: HFOV with high-volume strategy was able to improve rapidly and significantly O.I. in severe neonatal respiratory failure without increasing complications in survivors. Edema was present in all infants and this might depend on the relatively tardy use of HFOV that required higher mean airway pressures. A more precocious intervention has to be considered in clinical practice.