Hemodynamic effects of high frequency oscillatory ventilation versus conventional mechanical ventilation in term neonates with persistent pulmonary hypertension: a single-center randomized trial

BACKGROUND: We aimed to evaluate the hemodynamics in full-term neonates with persistent pulmonary hypertension (PPH) on high frequency oscillatory ventilation (HFOV) versus conventional mechanical ventilation (CMV). METHODS: This trial was conducted on 64 full-term neonates with PPH who needed MV and were randomly divided into two groups: group I: 32 neonates with PPH on HFOV, and group II: 32 neonates with PPH on CMV. Two neonates weaned early from group I, and another two neonates died in group II; they were excluded from the study. Heart rate (HR), systolic, diastolic, and mean blood pressure (SBP, DBP, MBP) were recorded. Echocardiography was performed to measure right ventricular diameter (RVD), right atrial diameter (RAD), mean pulmonary artery diameter (MPA), left ventricular dimensions, LV systolic function, tricuspid pressure gradient (TR PG), systolic pulmonary artery pressure (SPAP), tricuspid annulus plane systolic excursion (TAPSE), superior vena cava (SVC) flow, right and left ventricular output (RVO, LVO). Cerebral ultrasound was done to measure the resistive index (RI) of middle cerebral artery (MCA) and to detect intraventricular hemorrhage (IVH). All measurements were performed at day 1, 3, and 7. RESULTS: HR, RVD, RAD, and MPA significantly decreased, but SBP, DBP, MBP, LVO, LV dimensions, and function significantly increased in both groups at day 7. SPAP and TR PG decreased significantly at day 3 and 7; however, TAPSE and RVO increased significantly at day 3 and 7 in both groups. LVO and RVO increased more significantly at day 7 in the CMV group. SVC flow didn't differ significantly in both groups on follow-up. RI of MCA significantly decreased in the HFOV group only at day 7. Moreover, IVH was comparable in both groups. CONCLUSION: HFOV and CMV have positive comparable effects on hemodynamics in full-term neonates with PPH. CLINICAL TRIAL REGISTRATION: The study was registered at pan African clinical trial registry with registration number (PACTR202104624409011) with registration date 6th April 2021. Link for trial registration ( https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=15789 ).