The impact of early high-frequency ventilation uses in Brazilian preterm infants: an initiative to improve healthcare

O impacto do uso precoce da ventilação de alta frequência em recém-nascidos prematuros brasileiros: uma iniciativa para melhorar a assistência à saúde

ABSTRACT

Objective:  High-frequency ventilation (HFV) is often used when conventional methods fail. Some studies suggest early HFV intervention might benefit infants with severe lung issues. This study compares early HFV at initial signs of respiratory distress to its later use when conventional ventilation fails.

Methods:  We conducted a retrospective cohort study on infants born weighing less than 1500 grams and with a gestational age under 28 weeks from January 2017 to December 2020. A guideline for early HFV was introduced in 2019. We analyzed two periods: late HFV (2017–2018), where HFV was applied after conventional ventilation failure (respiratory rate >60 rpm and driving pressure >20 cmH₂O) to maintain pH >7.2 and PCO₂ <60 mmHg; and early HFV (2019-2020), initiated when mean airway pressure exceeded 10 cmH₂O and driving pressure >14 cmH₂O.

Results:  Of the 139 infants studied, 98 received early HFV, while 41 had late. Early and late HFV groups had similar gestational ages (26.1±2.2 vs. 26.4±2.4 weeks, p=0.47) and birth weights (777±255 vs. 797±260 grams, p=0.66). Early HFV reduced mechanical ventilation duration with a hazard ratio of 0.66 (0.45–0.97) and was not linked to increased risks of hypoxemia, hypercapnia, or neurological issues. Mortality rates increased with late HFV, AdjRR [1.64 (1.05; 2.60)].

Conclusions:  Early HFV is effective for preterm infants with respiratory issues, reducing ventilation time and mortality. While results are promising, further randomized studies are essential to validate these findings and guide clinical practice.

Keywords:
High-frequency ventilation; Mechanical ventilation; Preterm infant; Developing countries