Effect of volume guarantee-high frequency oscillatory ventilation on cerebral blood flow in preterm neonates

Background Preterm neonates with respiratory distress often require advanced ventilation strategies to prevent respiratory failure. High-frequency oscillatory ventilation (HFOV) with volume guarantee (VG) can be utilized as a lung-protective modality that reduces ventilation induced lung injury. However, its effect on cerebral hemodynamics remains unclear. Our study aimed to compare the impacts of HFOV-VG versus HFOV alone on cerebral blood flow velocity among preterm neonates with respiratory failure. Methods In this pilot randomized controlled trial, 60 premature newborns (gestational age of 35 weeks or less) with respiratory distress who failed on conventional mechanical ventilation (CMV) were randomized to receive either HFOV or HFOV-VG as rescue respiratory therapy. Doppler cerebral blood flow velocity measurements, intraventricular hemorrhage (IVH) incidence, carbon dioxide (CO 2 ) levels, and oxygen requirements were assessed at baseline, after 24 hours, and after 3 days of ventilation. Results There were no significant differences in cerebral blood flow velocity measurements or IVH incidence between the two groups across all time points ( p > 0.05). However, HFOV-VG demonstrated lower fluctuations in tidal volume, fewer out-of-target CO 2 episodes, and reduced oxygen requirements compared to HFOV alone. Conclusion HFOV-VG and HFOV alone showed comparable effects on cerebral blood flow and IVH incidence in premature neonates. HFOV-VG may offer additional advantages in maintaining stable ventilation parameters and minimizing CO 2 fluctuations, potentially reducing the risk of lung injury.