比较高频通气与常频通气.pdfVIP

RANDOMIZED TRIAL OF HIGH-FREQUENCY OSCILLATORY VENTILATION VERSUS CONVENTIONAL VENTILATION: EFFECT ON SYSTEMIC BLOOD FLOW IN VERY PRETERM INFANTS DAVID A. OSBORN, MM, FRACP, AND NICK EVANS , MRCPCH, DM Objective Low superior vena cava (SVC) flow is common in very preterm infants in the first day and strongly associated with periventricular hemorrhage and disability. We examined the effect of high-frequency oscillatory ventilation (HFOV) compared with conventional ventilation (CV) on SVC flow and right ventricular output. Methods Forty-five infants 29 weeks were randomized before 1 hour of age to HFOV or CV. Echocardiography was performed on 43 infants at 3, 10, and 24 hours of age. Infants with low SVC flow ( 50 mL/kg/min) or hypotension (mean blood pressure #20) were treated with volume and inotrope. Results Infants allocated to HFOV (n = 23) and to CV (n = 20) were well matched. There was a nonsignificant trend toward more infants on HFOV having SVC flow 50 mL/kg/min (48% vs 20%) and receiving volume and inotropes (61% vs 40%). There were no significant differences in mean SVC flow or right ventricular output at 3, 10, or 24 hours. Infants on HFOV had a significantly higher calculated upper body vascular resistance at 10 hours and mean blood pressure at 24 hours. Conclusions There were no significant adverse effects of HFOV on systemic blood flow in very preterm infants during the first 24 hours of life. (J Pediatr 2003;143:192-8) ung disease continues to be a major cause of morbidity and mortality in infants born extremely prematurely. Those infants who develop chronic lung disease are at increased risk of subsequent neurodevelopmental impairments.1-12 L