elective HFOV for neonatal ARDS

Importance Key clinical features of neonatal acute respiratory distress syndrome (NARDS) are broadly comparable to those observed in pediatric, and adult ARDS, except for insufficient evidences to recommend high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CMV) as the preferred fist-line therapy.
Objective We evaluated whether HFOV was superior to CMV in reducing bronchopulmonary dysplasia (BPD) among preterm infants (≤34 weeks) with NARDS.
Design, Setting, and Participants In this single-center randomized controlled trial conducted from August 2019 through December 2023, we enrolled preterm infants born between 25 and 34 weeks’ gestation with NARDS who were stabilized on CMV.
Intervention Participants were randomly assigned to continue CMV or transition to elective HFOV.
Main Outcomes and Measures The primary outcome was BPD; secondary outcomes included death, retinopathy of prematurity (ROP) (>2 stage), necrotizing enterocolitis (NEC) (≥2 stage), intraventricular hemorrhage (IVH) (≥3rd grade), air leak. Modified Poisson regression, ordinal regression and coz proportional hazard regression were applied for outcome risk assessment where applicable.
Results Elective HFOV reduced the risk of BPD by 8% (relative risk 0.92, 95% CI: 0.86–0.99), compared with CMV. No significant between-group differences were observed for death, ROP >2, NEC≥2, IVH≥3rd, air leak, or hsPDA.
Conclusions and Relevance Elective HFOV reduced the incidence and severity of BPD in preterm infants born ≤ 34 weeks with NARDS, compared with CMV.