First-Intention High-Frequency Jet Ventilation Versus Volume-Targeted Ventilation for Respiratory Distress Syndrome in Extremely Preterm Neonates

Abstract

Background:

High-frequency jet ventilation (HFVJ) delivers very small tidal volumes at supra-physiologic frequencies. Advantages of HFJV include minimizing lung trauma and allowing spontaneous breathing. The objective of this study was to examine whether elective (first-intention mechanical ventilation mode) use of HFJV, compared to conventional volume-targeted ventilation (VTV) in extremely preterm infants with respiratory distress syndrome (RDS), would be associated with lower incidence of bronchopulmonary dysplasia (BPD) and other adverse outcomes.

Methods:

We conducted a retrospective cohort study of all extremely preterm neonates with gestational age (GA) ≤28 weeks admitted to the neonatal intensive care unit between 2020-2023. Neonates intubated and receiving mechanical ventilation with either first intention HFJV or VTV were included in the analysis. We evaluated the perinatal and clinical characteristics between neonates of the HFJV and VTV groups, with a subgroup analysis including only neonates with mild/moderate RDS, defined by an oxygenation index > 5.

Results:

117 neonates, 24 neonates with a mean GA of 25.2 ± 1.6 weeks were started on HFJV, whereas 93 neonates with a mean GA of 26.4 ± 1.5 weeks (P = .001) were started on VTV. Neonates in the HFJV group had significantly higher rates of mild/moderate RDS, higher oxygenation indices on admission, higher inotrope use, and remained intubated for a significantly longer period of time. Despite these differences, there were no statistical differences in rates of BPD, survival, or the combined outcome of BPD or death between the two groups. When only neonates with mild/moderate RDS were analyzed, 22 neonates on first-intention HFJV (mean GA 25.3 ± 1.6 weeks) and 66 neonates on first-intention VTV (mean GA 26.3 ± 1.5 weeks), no differences were recorded in the duration of mechanical ventilation, although the oxygenation indices on admission were higher in the HFJV group. Neonates of the HFJV group had significantly lower rates of BPD, or combined BPD or death, compared to the VTV group. In multivariate regression analysis, HFJV mode was significantly associated with lower rates for BPD (OR 0.14, 95% CI 0.03-0.75), and combined BPD or death (OR 0.15, 95% CI 0.03-0.79).

Conclusions:

In extremely preterm neonates with mild/moderate RDS, first-intention HFJV was associated with lower rates of BPD or combined BPD or death, in comparison to VTV mode.