HFOV VS.CMV For Neonates With Acute Respiratory Distress Syndrome(Nards)

PART1 High-frequency oscillatory ventilation mode versus constant-frequency ventilation mode in neonatal ARDS:A retrospective studyObjectives: This study aimed to evaluate whether high-frequency oscillatory ventilation(HFOV)could reduce mortality and the incidence of bronchopulmonary dysplasia(BPD)of perinatal-onset neonatal acute respiratory distress syndrome(NARDS)comparedwithconventional mechanical ventilation(CMV).Methods: Medical records werecollected and retrospectively analyzed.Among the 700 neonates with NARDS who needed invasive ventilation,501(71.6%)received CMV,while 199(28.4%)received HFOV.One-to-one propensity score matching(127:127)was used to match the baseline characteristics of patients who received CMV and HFOV.Results: No significant differences were observed in mortality or the incidence of BPD between the two groups.The incidence of intraventricular hemorrhage(IVH)and ventilation-free days were significantly lower in the HFOV group thanin the CMV group(3.9 vs 11.80%,p=0.02;15.226 vs 20.967 days,p=0.01).There were no significant differences between the two groups regarding other secondary outcomes.Conclusion: HFOV was associated with a decreased incidence of IVH in infants with NARDScompared with CMV.However,there were significantly more VFDs in the CMV groupthan in the HFOV group,and HFOV did not appear to be superior to CMV in decreasing the mortality and incidence of BPD in infants with NARDS.PART 2 High-frequency oscillatory ventilation mode versus conventional mechanical ventilation mode in neonatal ARDS :A prospective randomized controlled studyObjective: To explore whether high-frequency oscillatory ventilation(HFOV)could reduce mortality and the incidence of bronchopulmonary dysplasia(BPD)of perinatal-onset neonatal acute respiratory distress syndrome(NARDS)compared with conventional mechanical ventilation(CMV).Methods: Neonates with ARDS were randomly assigned to highfrequency oscillatory ventilation or constant-frequency ventilation mode groups for a prospective study.Results: In a prospective randomized controlled study,a total of730 neonates were enrolled between October 2018 and December2021,364 cases in HFOV group and 366 cases in CMV group.The incidence of BPD was 16.2%(118/730),including 22 cases of moderate to severe BPD in the HFOV group and 44 cases of moderate-to-severe BPD in the CMV group.The incidence of moderate to severe BPD were significantly lower in the HFOVgroup than in the CMV group(6.0% vs 12.0%,p=0.005).The mortality of neonates with ARDS was 14.3%(104/ 730),of which 54 patients in the HFOV group and 50 patients in the CMV group.No significant differences were observed in mortality between the two groups(14.8%vs 13.7%,P=0.65).There were no significant differences between the two groups regarding other secondary outcomes,including IVH,ROP≥2nd,NEC≥2nd,air leak syndrome,patent ductus arteriosus(PDA)treatment rate,pulmonary surfactant use,invasive ventilation time,ventilatiorfree days(VFDs),hospitalization time,and hospitalization expenses(P>0.05).Conclusion: HFOV was associated with a decreased incidence of moderate to severe BPD in infants with NARDS compared with CMV.