Application of high frequency and low tidal volume in high frequency oscillatory ventilationcombined with volume assurance in the treatment of respiratory distress syndrome inpremature infants
Yuan Jing, Li Shufang, Zhang Yuezhe, et al
(1. the Second Department of Pediatrics, the First Hospital of Handan, Hebei, Handan 056000, China; 2. Department of Neonatology, the First Hospital of Handan, Hebei, Handan 056000, China; 3. Medical Department, the First Hospital of Handan, Hebei, Handan 056000, China)
Abstract: 【Abstract】 Objective To explore the application parameters of high frequency+low tidal volume strategy in the treatment of premature infants with respiratory distress syndrome (RDS) by high frequency oscillation ventilation (HFOV)- volume guarantee (VG) under the condition of sufficient ventilation. Method The method of retrospective epidemiological study was adopted. A total of 122 premature infants with RDS who were treated with HFOV-VG during hospitalization in the First Hospital of Handan from February 2017 to April 2021 were selected as the study objects. The premature infants were divided into 13-14 Hz group (n=7), 15-18 Hz group (n=105) and 19-20 Hz group (n=10) according to the ventilation frequency of respiratory therapy. The general data, ventilation indexes at 0 h and 24 h, and complications at 24 h after ventilation were compared among the three groups. The trend and correlation between ventilation frequency and tidal volume in children with RDS were analyzed. The statistical methods performed by one-way ANOVA, Kruskal-Wallis rank sum test, χ2 test, trend χ2 test and Pearson correlation analysis. Result In the 122 cases, 47 cases (38.5%) had RDS grade I, 58 cases (47.5%) had RDS gradeII, 15 cases (12.3%) had RDS grade III, and 2 cases (1.6%) had RDS grade IV. Comparison of the proportion of no antenatal application of glucocorticoids in different ventilation frequency groups [13-14 Hz group 14.3% (1/7) , 15-18 Hz group 19.1% (20/105) , 19-20 Hz group 20.0% (2/10)], with statistically significant differences (χ2=12.288, P<0.05), and with the increase of ventilation frequency, the proportion of single treatment and no application increased. There was no statistically significant difference in other general data of maternal and infants (all P>0.05). There was no statistically significant difference in the ventilation indexes of children with different ventilation frequencies at 0 h and 24 h, such as fraction of inspiration O2 (FiO2), oxygenation index (OI), mean airway pressure (MAP), and arterial partial pressure of carbon dioxide (PaCO2)(all P>0.05). There was no statistically significant difference in the incidence of complications such aspneumonia, sepsis, shock and pulmonary hemorrhage at 24 h after ventilation (all P>0.05). Univariate analysisof variance showed that the overall difference of tidal volume of RDS infants with different hyperventilationfrequencies was statistically significant (F=2.610, P=0.015). Tidal volume decreases linearly with the increaseof ventilation frequency (trend χ2=16.725, P<0.001). There was a significant negative correlation betweenventilation frequency and tidal volume in children with RDS (r=-0.296, P=0.001). Conclusion Under the ventilation strategy of 13-20 Hz frequency, the tidal volume parameter 0.9-2.3 ml/kg can achieve sufficient ventilation volume, which provides a treatment reference for premature infants with RDS.
原静 李书芳 张悦哲 孙园园 李艳民 魏燕云. 高频率和低潮气量在高频振荡通气联合容量保证治疗早产儿呼吸窘迫综合征中的应用研究[J]. 发育医学电子杂志, 2023, 11(2): 112-118.
Yuan Jing, Li Shufang, Zhang Yuezhe, et al. Application of high frequency and low tidal volume in high frequency oscillatory ventilationcombined with volume assurance in the treatment of respiratory distress syndrome inpremature infants. Journal of Developmental Medicine(Electronic Version), 2023, 11(2): 112-118.
2023, Vol. 11 
