High-frequency oscillatory ventilation versus conventional ventilation in a piglet model of early meconium aspiration.

OBJECTIVE

To compare the cardiopulmonary effects of high-frequency oscillatory ventilation (HFO) and conventional ventilation (CV) in a piglet model of meconium aspiration syndrome.

DESIGN

Prospective, randomized control study.

SUBJECTS

Piglets 1 to 2 wks of age.

INTERVENTIONS

Meconium aspiration was induced in 30 piglets. They were then randomized to CV, HFO at 10 Hz, or HFO at 15 Hz.

MEASUREMENTS AND MAIN RESULTS

Arterial blood gas, and systemic and pulmonary hemodynamics were measured serially. Airway opening pressure (P-Flex), static lung compliance (Crs), and trapped gas volume (TGV) were derived. Meconium instillation produced similar stable decreases in Crs (6.7 +/- 0.7 [SEM] to 4.7 +/- 0.4 mL/cm) and increases in pulmonary vascular resistance (68 +/- 6.4 vs. 91.9 +/- 8.5 mm Hg/mL/kg/min). A greater proportion of animals (40%, p< .007) remained hypercarbic during HFO at 15 Hz. Oxygenation indices were similar for all groups. In regards to high-frequency support, both power and deltaP were higher in the HFO at 15 Hz group (p< .001). When compared with both CV and HFO at 10 Hz, the TGV in the HFO at 15 Hz group was significantly higher following randomization to ventilator type. P-Flex was also greatest in the 15 Hz group, followed by the 10 Hz group and the CV group. Higher airway opening pressures, given identical compliance, suggest that HFO at 15 Hz resulted in greater large airway obstruction. With HFO's inherent low tidal volumes, progression of meconium to the distal airways may be delayed.

CONCLUSIONS

Early institution of HFO at 15 Hz in meconium aspiration may exacerbate air trapping. HFO at lower rates may be the optimal method of respiratory support in meconium aspiration syndrome. HFO may extend the window of time available for removal of meconium.