High-frequency oscillatory ventilation for the treatment of neonatal pneumothorax: clinical effects and tidal respiratory functional follow-up

Objective To evaluate the clinical effect of high-frequency oscillatory ventilation (HFOV) in the treatment of neonatal pneumothorax and its effect on respiratory tract diseases and tidal respiratory function in infancy. Methods From January 2012 to June 2015, 22 cases of neonatal pneumothorax who received mechanical ventilation in Yangzhou No.1 People′s Hospital were selected as study subjects. According to the different mechanical ventilation strategies, they were divided into conventional mechanical ventilation (CMV) group (n=12, received CMV treatment) and HFOV group (n=10, received HFOV treatment). Retrospective analysis was performed on clinical data, and the survivors received regular follow-up to 12 months corrected age. The thoracic closed drainage time, mechanical ventilation treatment time, high concentration oxygen inhaling time, total oxygen inhaling time and hospitalization time, as well as blood gas analysis and oxygenation index before(0 h) and after 8, 24 and 48 h of ventilation were compared between CMV and HFOV group. At 12 months corrected age, the tidal respiratory function parameters and respiratory tract disease follow-up results were also compared between two groups. There were no significant differences between two groups in general clinical data, such as gender constituent ratio, gestational age, body weight and the mode of delivery (P>0.05). Results ①The times of thoracic closed drainage, mechanical ventilation treatment and high concentration oxygen inhaled in HFOV group all were shorter than those of CMV group, and all the differences were statistically significant (P 0.05). ②There were no significant differences between two groups before treatment of mechanical ventilation (0 h) in pH value, partial pressure of oxygen in artery (PaO2), partial pressure of carbon dioxide in artery (PaCO2), oxygenation index (OI), arterial-alveolar oxygen gradient (PaO2/PAO2) and respiratory index (RI) (P>0.05). The pH value, PaO2and PaO2/PAO2of HFOV group after 8, 24, 48 h of ventilation were higher than those of CMV group, while the PaCO2,OI and RI were lower than those of CMV group, respectively, and all the differences were statistically significant (P 0.05), the other indicators after 8, 24, 48 h of mechanical ventilation treatment in both two groups were all improved compared with those of 0 h in same group, and the differences were statistically significant (P 0.05). Conclusions HFOV treatment for neonatal pneumothorax can significantly improve the blood gas analysis and oxygenation index, shorten thoracic closed drainage time, mechanical ventilation time and high concentration oxygen inhaling time, and without effecting on tidal respiratory function parameters and respiratory tract disease in infancy compared to CMV treatment. Key words: High-frequency ventilation; Pneumothorax; Respiration, artificial; Respiratory function tests; Infant, newborn