TY - JOUR
T1 - Conventional mechanical ventilation versus high-frequency oscillatory ventilation for congenital diaphragmatic hernia
T2 - A randomized clinical trial (The VICI-trial)
AU - Snoek, Kitty G.
AU - Capolupo, Irma Van
AU - Van Rosmalen, Joost
AU - De Jongste-Van Den Hout, Lieke
AU - Vijfhuize, Sanne
AU - Greenough, Anne
AU - Wijnen, René M.
AU - Tibboel, Dick
AU - Reiss, Irwin K M
AU - Di Pede, Alessandra
AU - Dotta, Andrea
AU - Bagolan, Pietro
AU - Kraemer, Ulrike
AU - Pinto, Carla
AU - Silva, Maria Gorett
AU - Saldanha, Joana
AU - Bhat, Prashanth
AU - Murthy, Vadivelam
AU - Van Heijst, Arno
AU - Schaible, Thomas
AU - Wessel, Lucas
AU - Allegaert, Karel
AU - Debeer, Anne
PY - 2016/5
Y1 - 2016/5
N2 - Objectives: To determine the optimal initial ventilation mode in congenital diaphragmatic hernia. Background: Congenital diaphragmatic hernia is a life-threatening anomaly with significant mortality and morbidity. The maldeveloped lungs have a high susceptibility for oxygen and ventilation damage resulting in a high incidence of bronchopulmonary dysplasia (BPD) and chronic respiratory morbidity. Methods: An international, multicenter study (NTR 1310), the VICI-trial was performed in prenatally diagnosed congenital diaphragmatic hernia infants (n = 171) born between November 2008 and December 2013, who were randomized for initial ventilation strategy. Results: Ninety-one (53.2%) patients initially received conventional mechanical ventilation and 80 (46.8%) high-frequency oscillation. Forty-one patients (45.1%) randomized to conventional mechanical ventilation died/had BPD compared with 43 patients (53.8%) in the high-frequency oscillation group. An odds ratio of 0.62 [95% confidence interval (95% CI) 0.25-1.55] (P = 0.31) for death/BPD for conventional mechanical ventilation vs highfrequency oscillation was demonstrated, after adjustment for center, head-lung ratio, side of the defect, and liver position. Patients initially ventilated by conventional mechanical ventilation were ventilated for fewer days (P = 0.03), less often needed extracorporeal membrane oxygenation support (P = 0.007), inhaled nitric oxide (P=0.045), sildenafil (P=0.004), had a shorter duration of vasoactive drugs (P = 0.02), and less often failed treatment (P = 0.01) as compared with infants initially ventilated by high-frequency oscillation. Conclusions: Our results show no statistically significant difference in the combined outcome of mortality or BPD between the 2 ventilation groups in prenatally diagnosed congenital diaphragmatic hernia infants. Other outcomes, including shorter ventilation time and lesser need of extracorporeal membrane oxygenation, favored conventional ventilation.
AB - Objectives: To determine the optimal initial ventilation mode in congenital diaphragmatic hernia. Background: Congenital diaphragmatic hernia is a life-threatening anomaly with significant mortality and morbidity. The maldeveloped lungs have a high susceptibility for oxygen and ventilation damage resulting in a high incidence of bronchopulmonary dysplasia (BPD) and chronic respiratory morbidity. Methods: An international, multicenter study (NTR 1310), the VICI-trial was performed in prenatally diagnosed congenital diaphragmatic hernia infants (n = 171) born between November 2008 and December 2013, who were randomized for initial ventilation strategy. Results: Ninety-one (53.2%) patients initially received conventional mechanical ventilation and 80 (46.8%) high-frequency oscillation. Forty-one patients (45.1%) randomized to conventional mechanical ventilation died/had BPD compared with 43 patients (53.8%) in the high-frequency oscillation group. An odds ratio of 0.62 [95% confidence interval (95% CI) 0.25-1.55] (P = 0.31) for death/BPD for conventional mechanical ventilation vs highfrequency oscillation was demonstrated, after adjustment for center, head-lung ratio, side of the defect, and liver position. Patients initially ventilated by conventional mechanical ventilation were ventilated for fewer days (P = 0.03), less often needed extracorporeal membrane oxygenation support (P = 0.007), inhaled nitric oxide (P=0.045), sildenafil (P=0.004), had a shorter duration of vasoactive drugs (P = 0.02), and less often failed treatment (P = 0.01) as compared with infants initially ventilated by high-frequency oscillation. Conclusions: Our results show no statistically significant difference in the combined outcome of mortality or BPD between the 2 ventilation groups in prenatally diagnosed congenital diaphragmatic hernia infants. Other outcomes, including shorter ventilation time and lesser need of extracorporeal membrane oxygenation, favored conventional ventilation.
KW - Congenital diaphragmatic hernia
KW - Conventional mechanical ventilation
KW - High-frequency oscillation
UR - http://www.scopus.com/inward/record.url?scp=84951310008&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000001533
DO - 10.1097/SLA.0000000000001533
M3 - Article
AN - SCOPUS:84951310008
SN - 0003-4932
VL - 263
SP - 867
EP - 874
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -