부산대학교 도서관

Background/aim: Severity of pulmonary dysfunction and later development of chronic lung disease in preterm neonates depends on several factors, including oxygen administration and ventilatory strategies. Aim of this report is the comparison of the effects of high-frequency oscillatory ventilation (HFOV) versus synchronized intermittent mandatory ventilation (sIMV) on serum cytokine levels (IL-6, IL-8, IL-10) during the first week of life.Methods: Forty preterm neonates with RDS and gestational age (GA) < 30 weeks were randomly assigned to one of the two above-mentioned ventilation strategies within 30 minutes from birth: Group HFOV: N: 20; mean GA: 27.1±1.4 wks; mean birth weight (BW): 882 ±157 g. Group sIMV: N: 20; mean GA: 27.4 ± 1.2 wks; mean BW: 936 ± 285 g. At 1, 3 and 5 days, the babies were monitored by means of ventilator indices and three pro-inflammatory cytokines in sera.Results: No clinical or biochemical differences were observed at baseline. The neonates assigned to HFOV benefited from early and sustained improvement in gas exchange (significantly lower FiO2 and significantly higher a/A ratio) with earlier extubation, and showed a significant reduction (p<0.05) of serum IL-6, IL-8 and IL-10 over time, as compared to the neonates assigned to sIMV treatment. In addition, at days 3 and 5, the IL-6 levels were significantly lower in the HFOV group as compared to sIMV patients [median (range) values: 7 (1–47) pg/ml vs 20 (4–144) pg/ml respectively at day 3, and 6 (2–44) pg/ml vs 14 (5–145) pg/ml at day 5, p<0.05].Conclusions: The results of this randomized clinical trial support the hypothesis that early use of HFOV, combined with optimum volume strategy, has a beneficial effect, reducing serum levels of pro-inflammatory cytokines and consequently the acute phase leading to lung injury.