Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation☆,☆☆,★
Section snippets
METHODS
Our study was a multicenter (n = 4) randomized comparison of HFO and conventional ventilation in the management of ECMO candidates. The study protocol was approved by the institutional review boards at each center and by the U.S. Food and Drug Administration. The four centers involved in this study were Egleston Children's Hospital and Grady Memorial Hospital, Atlanta, Ga.; Saint Luke's Regional Medical Center, Boise, Idaho; and Wilford Hall U.S. Air Force Medical Center, San Antonio, Tex.
RESULTS
Between Jan. 1, 1990, and Oct. 31, 1992, we enrolled 81 patients into the study. We dropped two patients from data analysis: one had total anomalous pulmonary venous return diagnosed after he entered the study, and one had Jeune syndrome. Seventy-nine neonates completed the study, 40 in the conventional ventilation group and 39 in the HFO group.
The median age at entry into the study was 29 hours (range 2 to 146 hours), and most of the neonates enrolled were outborn (83%). Fifty-three percent
DISCUSSION
This study shows that HFO improved gas exchange in 63% of the patients in whom conventional ventilation failed. Attempts to use conventional ventilation to rescue patients in whom HFO failed were not as effective; only 23% responded. Similar results were found in the subset of patients who met ECMO criteria. We believe that this study demonstrates that HFO is a useful adjunct to conventional ventilation in the management of neonates with respiratory failure.
Several previous studies have shown
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Opinions expressed are those of the authors and do not reflect those of the U.S. Air Force or the Department of Defense.
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Reprint requests: Reese H. Clark, MD, Department of Pediatrics, 2040 Ridgewood Dr. N.E., Atlanta, GA 30322.
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