Background Mechanical ventilation is required for survival of very low birth weight (VLBW; ≤ 1,250 g) premature infants. However, mechanical ventilation is also a common cause of chronic lung injury, also known as bronchopulmonary dysplasia (BPD), the primary cause of morbidity and mortality among surviving VLBW infants. High-frequency ventilation (HFV) differs from conventional modes in that it allows ventilation and oxygenation of the infant using higher mean airway pressures and smaller tidal volumes. Experimentally, HFV has been shown to improve lung function and protect against ventilator-induced injury in animal models. However, human studies are divergent as to whether HFV demonstrates a clinically significant advantage, and there are no large studies published to date evaluating the en route stability of neonates in whom HFV is used during transport. Therefore, we sought to describe our local experience using a newly implemented HFV transport ventilator, the Bronchotron®-I, in the transport of premature VLBW infants.
Methods VLBW neonates who were transported within the first 3 days of life by the Intermountain Health Care (IHC) LifeFlight program on HFV were evaluated by medical chart review for en route physiologic stability. All neonates were evaluated for physiologic stability and en route markers of deterioration.
Results Fifty-eight patients met the inclusion criteria (mean transport time 2.38 hours). All neonates tolerated the HFV ventilator en route. There were two instances of barotrauma during transport, neither of which was attributable to placement of the device. Arterial blood gases overall remained stable or improved during transport. For the majority of transports, mean blood pressure (MBP) also remained stable (n = 31; 54%) or showed a clinically significant (> 20%) improvement (n = 23; 40%).
Conclusions In our local experience, VLBW neonates in whom HFV was used during transport remained physiologically stable en route and did not appear to experience adverse sequelae attributable to use of the HFV device. We therefore conclude that the Bronchotron®-I appears to be a safe and effective method of ventilation during transport of VLBW neonates. Larger multicenter trials may help compare differences in en route stability for VLBW infants transported on conventional ventilation versus HFV.
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