Impact of Volume Guarantee on High-Frequency Oscillatory Ventilation in Preterm Infants: A Randomized Crossover Clinical Trial

Abstract

Background: High-frequency oscillatory ventilation (HFOV) with volume guarantee (VG) is a new ventilation mode that allows the clinician to set a mean tidal volume to be delivered. Objective: This study aimed to investigate whether HFOV with a VG option may result in constant tidal volume delivery and less fluctuant CO₂ levels compared to HFOV alone in premature infants with respiratory distress syndrome (RDS). Methods: Inborn infants at less than 32 weeks of gestation with RDS requiring invasive mechanical ventilation were eligible. Patients were randomized to receive HFOV + VG or HFOV alone as the initial ventilator mode and then crossed over to the other mode. HFOV was performed with ‘optimal lung volume strategy' during both of the periods. Results: Twenty infants were evaluated. The mean high-frequency tidal volume (VT_hf) and CO₂ diffusion coefficient (DCO₂) were significantly higher in the HFOV + VG mode than HFOV alone. HFOV + VG maintains VT_hf within the target range more consistently than HFOV. The incidences of hypocarbia and hypercarbia were lower in HFOV with VG than HFOV alone. Conclusion: This is the first prospective, randomized, short-term crossover clinical study that compared HFOV with and without VG in infants with acute RDS. Because of the lower VT_hf fluctuation and lower incidences of out-of-target PCO₂ levels, HFOV combined with VG seems to be feasible for preterm infants. However, the results should be interpreted with caution due to the small sample size and short-term crossover design of the study.