Abstract:OBJECTIVE: To study the effect of lung protective strategies of ventilation on the term neonates with hypoxemic respiratory failure (HRF). METHODS: Fifty-three term neonates with HRF were randomly divided into two groups: lung protective ventilation (LPV) group (n=27) and conventional mechanical ventilation (CMV) group (n=26). The parameters of ventilation, results of blood-gas analysis, incidences of ventilator-associated lung injury, intraventicular hemorrhage (IVH) and patent ductus arteriosus (PDA), and mortality were compared. RESULTS: In the peak stage of HRF, peak inflation pressure (PIP) and mean airway pressure (MAP) were 2.50±0.28 and 1.04±0.25 kPa respectively in the LPV group, significantly lower than those in the CMV group (2.97±0.35 and 1.28±0.30 kPa, P<0.01). Positive end-expiratory pressure (PEEP) in the LPV group was significantly higher than that in the CMV group (0.61±0.08 kPa vs 0.53±0.09 kPa, P<0.01). There were no differences in fraction of inspired oxygen (FiO_2), inspiratory time (Ti) and ventilation rate between the two groups. The pH (7.29±0.10) in the LPV group was lower than that in the CMV group (7.38±0.12, P<0.01), but PaCO_2 (7.13±1.02 kPa) was higher than that in the CMV group (5.40±1.06 kPa, P<0.01). The PaO_2 and SaO_2 of the LPV group were not different from those of the CMV group. The LPV group showed lower incidence of air leak (4% vs 35%, P<0.01) and similar incidences of IVH, PDA and lung hemorrhage to the CMV group. LPV resulted in a decreased mortality compared with CMV (11%(3/27) vs 35%(9/26), P<0.05). CONCLUSIONS: Using lung protective strategies in mechanical ventilation can markedly reduce the incidence of air leak and mortality for neonates with HRF.
