Tao Min, Yan Ling, Hu Yuan, Shen Leilei, Cai Na
Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing, 400038, People's Republic of China.
Int J Gen Med. 2025 Aug 24;18:4695-4708. doi: 10.2147/IJGM.S534091. eCollection 2025.
This study aimed to explore whether high-frequency oscillatory ventilation with volume-guarantee (HFOV-VG) strategy could reduce the incidence of bronchopulmonary dysplasia (BPD) and improve poor neurological prognosis in premature infants with perinatal acute respiratory distress syndrome (NARDS) compared with high-frequency oscillatory ventilation (HFOV) alone.
This retrospective single-center study conducted in the neonatal intensive care unit (NICU) from January 2016 and December 2023. One hundred and seventy-two premature infants (32 weeks ≤ gestational age < 37 weeks) with NARDS were enrolled. Infants were categorized into two groups based on ventilation strategy: HFOV-VG (n = 70) and HFOV (n = 102). The demographic data, perinatal factors, primary and secondary outcomes were compared. Univariate and multivariate logistic regression analyses were performed to assess the association between the ventilation strategy and primary outcomes.
The invasive mechanical ventilation duration and incidence of BPD in HFOV-VG group were lower than those in HFOV group. There were no significant differences in complication, and the scores of neurobehavioral development between the two groups of children who were followed up until correct age of 6 months. The multivariate logistic regression analysis identified that the ventilation strategy of HFOV-VG was an independent protective factor of BPD. However, HFOV-VG was not associated with a statistically significant improvement in short-term neurodevelopmental outcomes. Subgroup analysis showed that there were no significant interactions in any of the subgroups except for birth weight subgroup. The association between HFOV-VG mode and the incidence of BPD was more pronounced in neonates with birth weight < 2500g.
The ventilation strategy of HFOV-VG was a promising lung protective mode for premature infants with perinatal ARDS, which can shorten mechanical ventilation duration and may reduce the incidence of BPD. However, it did not seem to be superior to HFOV in improving short-term neurodevelopmental outcomes.
本研究旨在探讨与单纯高频振荡通气（HFOV）相比，容量保证高频振荡通气（HFOV-VG）策略能否降低围生期急性呼吸窘迫综合征（NARDS）早产儿支气管肺发育不良（BPD）的发生率，并改善其不良神经预后。
本回顾性单中心研究于2016年1月至2023年12月在新生儿重症监护病房（NICU）进行。纳入172例孕周32周≤胎龄<37周的NARDS早产儿。根据通气策略将婴儿分为两组：HFOV-VG组（n = 70）和HFOV组（n = 102）。比较两组的人口统计学数据、围生期因素、主要和次要结局。进行单因素和多因素逻辑回归分析，以评估通气策略与主要结局之间的关联。
HFOV-VG组的有创机械通气时间和BPD发生率低于HFOV组。两组并发症以及随访至6个月矫正年龄时儿童神经行为发育评分无显著差异。多因素逻辑回归分析确定HFOV-VG通气策略是BPD的独立保护因素。然而，HFOV-VG与短期神经发育结局的统计学显著改善无关。亚组分析显示，除出生体重亚组外，其他亚组均无显著交互作用。出生体重<2500g的新生儿中，HFOV-VG模式与BPD发生率之间的关联更为明显。
HFOV-VG通气策略是一种有前景的围生期ARDS早产儿肺保护模式，可缩短机械通气时间，并可能降低BPD的发生率。然而，在改善短期神经发育结局方面，它似乎并不优于HFOV。
