{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:03:41Z","timestamp":1789736621382,"version":"4.0.1"},"reference-count":33,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1997,10,1]]},"abstract":"<jats:p>Objective.\u2003To test the hypothesis that high-frequency jet ventilation (HFJV) will reduce the incidence and\/or severity of bronchopulmonary dysplasia (BPD) and acute airleak in premature infants who, despite surfactant administration, require mechanical ventilation for respiratory distress syndrome.<\/jats:p><jats:p>Design.\u2003Multicenter, randomized, controlled clinical trial of HFJV and conventional ventilation (CV). Patients were to remain on assigned therapy for 14 days or until extubation, whichever came first. Crossover from CV to HFJV was allowed if bilateral pulmonary interstitial emphysema or bronchopleural fistula developed. Patients could cross over to the other ventilatory mode if failure criteria were met. The optimal lung volume strategy was mandated for HFJV by protocol to provide alveolar recruitment and optimize lung volume and ventilation\/perfusion matching, while minimizing pressure amplitude and O2 requirements. CV management was not controlled by protocol.<\/jats:p><jats:p>Setting.\u2003Eight tertiary neonatal intensive care units.<\/jats:p><jats:p>Patients.\u2003Preterm infants with birth weights between 700 and 1500 g and gestational age &amp;lt;36 weeks who required mechanical ventilation with Fio2 &amp;gt;0.30 at 2 to 12 hours after surfactant administration, received surfactant by 8 hours of age, were &amp;lt;20 hours old, and had been ventilated for &amp;lt;12 hours.<\/jats:p><jats:p>Outcome Measures.\u2003Primary outcome variables were BPD at 28 days and 36 weeks of postconceptional age. Secondary outcome variables were survival, gas exchange, airway pressures, airleak, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and other nonpulmonary complications.<\/jats:p><jats:p>Results.\u2003A total of 130 patients were included in the final analysis; 65 were randomized to HFJV and 65 to CV. The groups were of comparable birth weight, gestational age, severity of illness, postnatal age, and other demographics. The incidence of BPD at 36 weeks of postconceptional age was significantly lower in babies randomized to HFJV compared with CV (20.0% vs 40.4%). The need for home oxygen was also significantly lower in infants receiving HFJV compared with CV (5.5% vs 23.1%). Survival, incidence of BPD at 28 days, retinopathy of prematurity, airleak, pulmonary hemorrhage, grade I\u2013II IVH, and other complications were similar. In retrospect, it was noted that the traditional HFJV strategy emphasizing low airway pressures (HF-LO) rather than the prescribed optimal volume strategy (HF-OPT) was used in 29\/65 HFJV infants. This presented a unique opportunity to examine the effects of different HFJV strategies on gas exchange, airway pressures, and outcomes. HF-OPT was defined as increase in positive end-expiratory pressure (PEEP) by \u22651 cm H2O from pre-HFJV baseline and\/or use of PEEP of \u22657 cm H2O. Severe neuroimaging abnormalities (PVL and\/or grade III\u2013IV IVH) were not different between the CV and HFJV infants. However, there was a significantly lower incidence of severe IVH\/PVL in HFJV infants treated with HF-OPT compared with CV and HF-LO. Oxygenation was similar between CV and HFJV groups as a whole, but HF-OPT infants had better oxygenation compared with the other two groups. There were no differences in Paco2 between CV and HFJV, but the Paco2 was lower for HF-LO compared with the other two groups. The peak inspiratory pressure and \u0394P (peak inspiratory pressure-PEEP) were lower for HFJV infants compared with CV infants.<\/jats:p><jats:p>Conclusions.\u2003HFJV reduces the incidence of BPD at 36 weeks and the need for home oxygen in premature infants with uncomplicated RDS, but does not reduce the risk of acute airleak. There is no increase in adverse outcomes compared with CV. HF-OPT improves oxygenation, decreases exposure to hypocarbia, and reduces the risk of grade III\u2013IV IVH and\/or PVL.<\/jats:p>","DOI":"10.1542\/peds.100.4.593","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:40:17Z","timestamp":1092440417000},"page":"593-599","source":"Crossref","is-referenced-by-count":154,"title":["Multicenter Controlled Clinical Trial of High-frequency Jet Ventilation in Preterm Infants With Uncomplicated Respiratory Distress Syndrome"],"prefix":"10.1542","volume":"100","author":[{"given":"Martin","family":"Keszler","sequence":"first","affiliation":[{"name":"From the Departments of Pediatrics, Georgetown University, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houchang D.","family":"Modanlou","sequence":"additional","affiliation":[{"name":"University of California at Irvine, Irvine, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Spencer","family":"Brudno","sequence":"additional","affiliation":[{"name":"Medical College of Georgia, Augusta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank I.","family":"Clark","sequence":"additional","affiliation":[{"name":"University of Missouri, Columbia, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald S.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Stanford University, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita M.","family":"Ryan","sequence":"additional","affiliation":[{"name":"University of Rochester, Rochester, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark K.","family":"Kaneta","sequence":"additional","affiliation":[{"name":"University Medical Center of Southern Nevada, Las Vegas, Nevada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M.","family":"Davis","sequence":"additional","affiliation":[{"name":"Winthrop University Hospital, SUNY Stony Brook School of Medicine, Mineola, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[1997,10,1]]},"reference":[{"key":"2021120904413746600_B1","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1542\/peds.75.4.657","article-title":"Neonatal high-frequency jet ventilation: four years' experience.","volume":"75","author":"Boros","year":"1985","journal-title":"Pediatrics."},{"key":"2021120904413746600_B2","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1002\/ppul.1950070410","article-title":"The ventilatory response to combined high frequency jet ventilation and conventional mechanical ventilation for the rescue treatment of severe neonatal lung disease.","volume":"7","author":"Spitzer","year":"1989","journal-title":"Pediatr Pulmonol."},{"key":"2021120904413746600_B3","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0022-3476(05)81046-7","article-title":"Multi center controlled trial of high-frequency jet ventilation and conventional ventilation in newborn infants with pulmonary interstitial emphysema.","volume":"119","author":"Keszler","year":"1991","journal-title":"J Pediatr."},{"key":"2021120904413746600_B4","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/S0022-3476(87)80518-8","article-title":"Decreased gas flow through pneumothoraces in neonates receiving high-frequency jet versus conventional ventilation.","volume":"110","author":"Gonzalez","year":"1987","journal-title":"J Pediatr."},{"key":"2021120904413746600_B5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1542\/peds.89.1.5","article-title":"Prospective randomized comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome.","volume":"89","author":"Clark","year":"1992","journal-title":"Pediatrics."},{"key":"2021120904413746600_B6","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1542\/peds.98.6.1044","article-title":"The Provo multi center early high-frequency oscillatory ventilation trial: improved pulmonary and clinical outcome in respiratory distress syndrome.","volume":"98","author":"Gerstmann","year":"1996","journal-title":"Pediatrics."},{"key":"2021120904413746600_B7","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1164\/ajrccm\/148.3.569","article-title":"Optimizing alveolar expansion prolongs the effectiveness of exogenous surfactant therapy in the adult rabbit.","volume":"148","author":"Froese","year":"1993","journal-title":"Am Rev Respir Dis."},{"key":"2021120904413746600_B8"},{"key":"2021120904413746600_B9","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1111\/j.1399-6576.1989.tb03013.x","article-title":"A comparison of ventilation strategies for the use of high frequency oscillatory ventilation in the treatment of hyaline membrane disease.","volume":"33(suppl 90)","author":"deLemos","year":"1989","journal-title":"Acta Anesthesiol Scand."},{"key":"2021120904413746600_B10","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S0095-5108(18)30513-X","article-title":"High frequency ventilation: issues of strategy.","volume":"18","author":"Gerstmann","year":"1991","journal-title":"Clin Perinatol."},{"key":"2021120904413746600_B11","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1542\/peds.98.6.1035","article-title":"High-frequency jet ventilation in the early management of respiratory distress syndrome is associated with a greater risk for adverse outcomes.","volume":"98","author":"Wiswell","year":"1996","journal-title":"Pediatrics."},{"key":"2021120904413746600_B12","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1542\/peds.88.1.189","article-title":"The BPD problem.","volume":"88","author":"Merritt","year":"1991","journal-title":"Pediatrics."},{"key":"2021120904413746600_B13","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1542\/peds.86.5.788","article-title":"Predicting risk for bronchopulmonary dysplasia.","volume":"86","author":"Dunn","year":"1990","journal-title":"Pediatrics."},{"key":"2021120904413746600_B14","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1542\/peds.82.4.527","article-title":"Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period.","volume":"82","author":"Shennan","year":"1988","journal-title":"Pediatrics."},{"key":"2021120904413746600_B15","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1542\/peds.90.4.515","article-title":"Mechanical ventilation in preterm infants: neurosonographic and developmental studies.","volume":"90","author":"Graziani","year":"1992","journal-title":"Pediatrics."},{"key":"2021120904413746600_B16","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1542\/peds.98.5.918","article-title":"Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation.","volume":"98","author":"Wiswell","year":"1996","journal-title":"Pediatrics."},{"key":"2021120904413746600_B17","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1651-2227.1987.tb10456.x","article-title":"Etiological factors associated with the development of periventricular leucomalacia.","volume":"76","author":"Calvert","year":"1987","journal-title":"Acta Pediatr Scand."},{"key":"2021120904413746600_B18","doi-asserted-by":"crossref","first-page":"F107","DOI":"10.1136\/fn.71.2.F107","article-title":"Hypocarbia and cystic periventricular leucomalacia in premature infants.","volume":"71","author":"Fujimoto","year":"1994","journal-title":"Arch Dis Child."},{"key":"2021120904413746600_B19","first-page":"657","article-title":"Duration of hyperventilation and outcome in infants with persistent pulmonary hypertension.","volume":"81","author":"Bifano","year":"1988","journal-title":"Pediatrics."},{"key":"2021120904413746600_B20","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1542\/peds.81.5.650","article-title":"Hearing loss in infants with persistent fetal circulation.","volume":"81","author":"Hendricks-Munoz","year":"1988","journal-title":"Pediatrics."},{"key":"2021120904413746600_B21","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1203\/00006450-198602000-00010","article-title":"Alterations in cerebral blood flow and oxygen consumption during prolonged hypocarbia.","volume":"20","author":"Hansen","year":"1986","journal-title":"Pediatr Res."},{"key":"2021120904413746600_B22","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1056\/NEJM198901123200204","article-title":"High frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants.","volume":"320","author":"The","year":"1989","journal-title":"N Engl J Med."},{"key":"2021120904413746600_B23","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1542\/peds.87.4.565","article-title":"Reflections on the HIFI trial.","volume":"87","author":"Bryan","year":"1991","journal-title":"Pediatrics."},{"key":"2021120904413746600_B24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0378-3782(93)90088-C","article-title":"A Multi center randomized trial of high-frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory distress syndrome.","volume":"32","author":"Ogawa","year":"1993","journal-title":"Early Hum Dev."},{"key":"2021120904413746600_B25","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S0022-3476(05)83548-6","article-title":"Randomized study of high-frequency oscillatory ventilation in infants with severe respiratory distress syndrome.","volume":"122","author":"HIFO Study Group","year":"1993","journal-title":"J Pediatr."},{"key":"2021120904413746600_B26","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1164\/ajrccm\/137.5.1185","article-title":"Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant deficient rabbits.","volume":"137","author":"McCulloch","year":"1988","journal-title":"Am Rev Respir Dis."},{"key":"2021120904413746600_B27","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.1152\/jappl.1989.66.5.2150","article-title":"Role of lung injury in the pathogenesis of hyaline membrane disease in premature baboons.","volume":"66","author":"Meredith","year":"1989","journal-title":"J Appl Physiol."},{"key":"2021120904413746600_B28","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1213\/00000539-198204000-00003","article-title":"Oxygenation during high frequency ventilation compared with conventional mechanical ventilation in two models of lung injury.","volume":"61","author":"Kolton","year":"1982","journal-title":"Anesth Analg."},{"key":"2021120904413746600_B29","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1152\/jappl.1988.64.4.1607","article-title":"Lung volume recruitment during high frequency oscillation in atelectasis-prone rabbits.","volume":"64","author":"Byford","year":"1988","journal-title":"J Appl Physiol."},{"key":"2021120904413746600_B30","first-page":"305A","article-title":"High frequency jet ventilation preceded by lung volume recruitment decreases hyaline membrane formation in surfactant deficient lungs.","volume":"27","author":"Hamm","year":"1990","journal-title":"Pediatr Res."},{"key":"2021120904413746600_B31","first-page":"A123","article-title":"Lung volume maintenance during high-frequency jet ventilation improves physiological and biochemical outcome of lavaged rabbit lung.","volume":"33","author":"Sugiura","year":"1990","journal-title":"Physiologist."},{"key":"2021120904413746600_B32","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/S0022-3476(84)80604-6","article-title":"Decrease in airway pressure during high-frequency jet ventilation in infants with respiratory distress syndrome.","volume":"104","author":"Carlo","year":"1984","journal-title":"J Pediatr."},{"key":"2021120904413746600_B33","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0022-3476(87)80173-7","article-title":"Randomized trial of high frequency jet ventilation versus conventional ventilation in respiratory distress syndrome.","volume":"110","author":"Carlo","year":"1987","journal-title":"J Pediatr."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/100\/4\/593\/889457\/pe109700593o.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/100\/4\/593\/889457\/pe109700593o.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:31:15Z","timestamp":1682746275000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/100\/4\/593\/52183\/Multicenter-Controlled-Clinical-Trial-of-High"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,10,1]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[1997,10,1]]},"published-print":{"date-parts":[[1997,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.100.4.593","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[1997,10,1]]}}}