Clinical Analysis Of High-frequency Oscillatory Ventilation Combined With Pulmonary Surfactant In The Treatment Of Neonatal Respiratory Failure

BackgroundNeonatal respiratory failure（NRF）is one of the most critical diseases in neonates,which needs mechanical ventilation in NICU.Meconium aspiration syndrome（MAS）,severe pneumonia,and acute respiratory distress syndrome（ARDS）are the main causes of respiratory failure,not only require mechanical ventilation,sometimes also need pulmonary surfactant administration.Pulmonary surfactant can decrease lung surface tension,promote lung inflation.Compared with conventional ventilation,high-frequency oscillatory ventilation（HFOV）has relative stable airway pressure and lower tidal volume.If used properly,HFOV can provide lung-protective ventilation.This study aims to observe the clinical effect of HFOV combined with pulmonary surfactant（PS）in the treatment of neonatal respiratory failure.ObjectivesTo compare the clinical effects of convential ventilation and high frequency ventilation combined with pulmonary surfactant in the treatment of neonatal respiratory failure.MethodsEighty-six neonates with respiratory failure who need ventilation in the Department of Neonatology,Zhumadian First People’s Hospital from January 2018 to January 2019 were enrolled and randomly divided into two groups,43 cases in each groups.The HFOV group included 20 females and 23 males,the gestational ages were（36.0±5.3）weeks;the ages were（30.9±8.7）h,the birth weights were（3238±247）g.There were 9 cases of primary severe pneumonia,10cases of meconium aspiration syndrome,and 24 cases of ARDS.The CMV group included 21 males and 22 females,the gestational ages were（36.2±5.4）weeks,the ages were（30.1±9.2）h,and the birth weights were（3209±235）g;there were 8 cases of primary severe pneumonia,12 cases of meconium aspiration syndrome,and 23 cases of ARDS.There was no statistically difference between the two groups in gender,age,and birth weight（p>0.05）.The two groups were treated according to the primary disease,including anti-infective,maintaining fluid balance,and improving circulation.The parameters of ventilator were set and adjusted in accordance with the“Pediatric Mechanical Ventilation”,clinical conditions,laboratory results,and images.Both groups were administrated with pulmonary surfactant（Poractant Alfa injection,200mg/Kg）through endotracheal tube within 1 hour of intubation.The PaO₂,PaCO₂,a/A PaO₂,SaO₂,and OI valueswere observed,recorded and compared.At last,the complications such as PDA,BPD,VAP,intracranial hemorrhage were recorded.Result1.Improvement of oxygenation:There was no statistical difference in PaO₂ and SaO₂ between the two groups before treatment（p>0.05）.After 12 hours and 24 hours respectively,the PaO₂ and SaO₂ of the two groups both showed gradually increasement.Compared with the CMV group,the PaO₂ and SaO₂ of the HFOV group improved better,and the difference was statistically significant（p<0.05）.There was no significant difference in a/APaO₂ and OI between the two groups within 1 hour of intubation（p>0.05）.After 12 hours and 24 hours of treatment,the OI of the two groups decreased gradually.Compared with the CMV group,the OI of the HFOV group decreased more,and the difference was statistically significant（p<0.05）.a/APaO₂showed a gradual increase,and compared with the CMV group,the increasement of a/APaO₂in the HFOV group was more significant,the difference was statistically significant（p<0.05）.2.Improvement of ventilation:There was no difference in PaCO₂ between the two groups before treatments（p>0.05）.Compared with CMV group,PaCO₂ of the two groups showed a significant decreasement in the HFOV group,and the difference was statistically significant（p<0.05）.3.Complications:The incidence of BPD,pulmonary hemorrhage,intracranial hemorrhage,VAP,and PDA were similar in the two groups（p>0.05）,but the incidence of air leak syndrome in the HFOV group was lower than that in the CMV group,the difference was statistically significant（p<0.05）.ConclusionsIn the treatment of neonatal respiratory failure.,HFOV combined with PS have advantages over CMV combined with PS in oxygenation and ventilation.HFOV also have lower risk in air leak syndrome.