Volume guarantee versus high frequency ventilation: lung inflammation in preterm infants

Abstract

Objective: Appropriate ventilation together with improvement of clinical care of premature babies can contribute to reducing lung inflammation, known to represent the “primum movens” of bronchopulmonary dysplasia (BPD). High frequency oscillatory ventilation (HFOV) and volume-guarantee (VG) ventilation are effective in the treatment of neonatal RDS. In order to assess the potential of these techniques to prevent BPD, we performed a randomized clinical study to evaluate lung inflammation in premature infants undergoing VG ventilation versus HFOV in acute phase of RDS.

Study design: Forty infants (GA 25-32 wks) with RDS were assigned to assist-control ventilation plus VG (Vt=5 ml/Kg) or HFOV (both with Dräger Babylog 8000 plus ventilator). Levels of interleukin-6, interleukin-8 and tumor necrosis factor were determined in tracheal aspirate on days 1,3 and 7 of life.

Results: In the HFOV group IL-6 levels were significantly higher on day 3 (0.5 ± 0.2 vs assisted- control ventilation plus VG group 0.1 ± 0.2 ng/ml) and oxygen dependency was significantly longer (36±23 vs assisted-control ventilation plus VG group 19 ± 11 days).

Conclusion: VG-ventilation is an effective lung- protective strategy to be used in acute RDS, inducing a lower expression of early inflammation markers when compared to HFOV. Whether the use of this initial ventilatory strategy contributes to the prevention of BPD requires further studies.