Conventional ventilation versus high-frequency oscillation: hemodynamic effects in newborn babies.

Abstract

We conducted a prospective study to assess the hemodynamic effects of conventional mechanical ventilation (CMV) compared with high-frequency oscillation (HFO) in newborn babies with respiratory distress syndrome. A total of 18 consecutive term and preterm infants were examined by two-dimensional M-mode and pulsed Doppler echocardiography. Five patients had to be excluded, three of them because of increasing cardiovascular support after initiation of HFO. The remaining 13 infants (seven males, six females) had a median gestational age of 33 wks (range, 25-40) and a birth weight of 2350 g (range, 790-3600). Patients entered the study at 21 hrs (range, 5-69) of life, receiving total maintenance fluid of 90 mL/kg/day (range, 60-120). Five babies (38%) needed continuous inotropic support. HFO was used as a rescue therapy in infants who failed with CMV. In all 13 patients, HFO significantly impaired cardiac performance compared with CMV by decreasing aortic velocity-time integral: median, 10.2 cm (range, 6.0-14.6) vs. 8.3 cm (range, 5.3-12.4; p<.002); stroke volume: median, 3.8 mL (range, 1.6-6.8) vs. 3.2 mL (range, 1.3-5.9; p<.002); and cardiac index: 281 mL/min/kg of body weight (range, 177-579) vs. 200 mL/min/kg of body weight (range, 156-591; p<.002). Fractional shortening was also significantly reduced: median, 0.31% (range, 0.24-0.44) vs. 0.29% (range, 0.20-0.34; p<.01), because of a significantly smaller left ventricular diastolic diameter during HFO: median, 1.4 cm (range, 1.0-1.9) vs. 1.4 cm (range, 0.9-1.8; p<.05), with a median difference of -0.07 cm (range, -0.4-0.2). HFO also causes a significant decrease in heart rate-corrected left ventricular ejection time: median, 0.25 sec (range, 0.23-0.28) vs. 0.23 sec (range, 0.21-0.26; p < .02) and heart rate-corrected velocity of circumferential fiber shortening (Vcfc): median, 1.3 circ/sec (range, 1.0-1.6) vs. 1.2 circ/sec (range, 0.9-1.4; p<.05). Left ventricular end-systolic wall stress (LVESWS; g/cm2) remained stable. The correlation between Vcfc and LVESWS did not show any significance (CMV, r2 = .2; HFO, r2 = .09). The regression line between Vcfc and LVESWS showed a higher y-intercept and steeper slope during CMV than during HFO. Heart rate, mean arterial pressure, and left ventricular systolic diameter remained unchanged. In newborn babies, HFO significantly decreased left ventricular cardiac output caused by reduced left ventricular filling and HFO decreased contractility at higher mean airway pressures than with CMV.