To determine the relative roles of high frequency oscillatory ventilation(HFOV) and inhaled nitric oxide (NO) in the treatment of severe PPHN, we enrolled 205 extracorporeal membrane oxygenation (ECMO) candidates in a multicenter clinical trial of HFOV and NO. Patients were stratified by predominant disease category (RDS-diffuse parenchymal disease, N = 70; MAS-meconium aspiration syndrome, N = 58; Other-idiopathic PPHN or non-CDH hypoplasia, N = 43; and CDH-congenital diaphragmatic hernia, N = 34); then randomized to treatment with NO or HFOV. Treatment failure (PaO2 < 60 mmHg) resulted in crossover to the alternative treatment; treatment failure after crossover allowed combined treatment with HFOV + NO. Baseline oxygenation index and PaO2 were 48 ± 31(SD) and 42 ± 15(SD) torr respectively, on conventional ventilation. Treatment response was defined as survival to discharge without the need for ECMO with the assigned treatment; cumulative outcomes by category are shown below (% responders). Marked differences in outcomes were noted between centers (% death/ECMO range= 29% - 75%). We conclude that treatment with HFOV + NO is often more succesful than HFOV or NO alone in severe PPHN. Differences in responses are partly related to the specific disease associated with PPHN.Table
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Kinsella, J., Truog, W., Walsh, W. et al. RANDOMIZED, MULTICENTER TRIAL OF INHALED NITRIC OXIDE AND HIGH FREQUENCY OSCILLATORY VENTILATION IN SEVERE PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (PPHN). • 1315. Pediatr Res 39 (Suppl 4), 222 (1996). https://doi.org/10.1203/00006450-199604001-01338
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DOI: https://doi.org/10.1203/00006450-199604001-01338