human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective Morbidity and mortality remain high amongst babies ventilated for a respiratory distress syndrome ( RDS ) . Whether newly developed ventilators allowing high frequency ventilation such as high frequency flow interrupted ventilation ( HFFIV ) could decrease the morbidity and the mortality was investigated in a r and omized study . Design Preterm babies weighing ≤1800 g suffering from RDS and ventilated by conventional mechanical ventilation ( CMV )  were r and omized to be further ventilated either by CMV ( group CMV ) or by HFFIV ( group HFFIV ) when peak inspiratory pressure ( PIP ) on CMV was ≥20cmH2O . Setting The study was undertaken in the neonatal intensive care unit of the Erasmus Hospital . Patients 24 patients entered into the investigation and were r and omized but 2 patients were removed from the study because the switch over to HFFIV failed . Eight of the 12 CMV  patients and 5 of the 10 HFFIV  patients completed the study . Measurements and results Clinical variables , blood gas analysis and ventilatory variables were looked at . There were no differences in mortality , in incidence of air leaks and pulmonary complications or in blood gas analysis . Bronchopulmonary dysplasia was not decreased by the use of HFFIV . Conclusion It is concluded that HFFIV  is safe although it offers no concrete advantages over CMV when applied as we did in a low pressure approach We set out to evaluate the impact of volume-targeted synchronized ventilation and conventional intermittent m and atory ventilation ( IMV ) on the early physiologic response to surfactant replacement therapy in neonates with respiratory distress syndrome ( RDS ) . We hypothesized that volume-targeted , patient-triggered synchronized ventilation would stabilize minute ventilation at a lower respiratory rate than that seen during volume-targeted IMV , and that synchronization would improve oxygenation and decrease variation in measured tidal volume ( V(t ) ) . This was a prospect i ve , r and omized study of 30 hospitalized neonates with RDS . Infants were r and omly assigned to volume-targeted ventilation using IMV ( n = 10 ) , synchronized IMV ( SIMV ; n = 10 ) , or assist/control ventilation ( A/C ; n = 10 ) after meeting eligibility requirements and before initial surfactant treatment . Following measurements of arterial blood gases and cardiovascular and respiratory parameters , infants received surfactant . Infants were studied for 6 hr following surfactant treatment . Infants assigned to each mode of ventilation had similar birth weight , gestational age , and Apgar scores at birth , and similar oxygenation indices at r and omization . Three patients were eliminated from final data analysis because of exclusionary conditions unknown at r and omization . Oxygenation improved significantly following surfactant therapy in all groups by 1 hr after surfactant treatment ( P < 0.05 ) . No further improvements occurred with time . Total respiratory rate was lowest ( P < 0.05 ) and variation in tidal volume ( V(t ) ) was least in the A/C group ( P < 0 . 05 ) . Minute ventilation ( V(')(E ) ) , delivered airway pressures , respiratory system mechanics , and hemodynamic parameters were similar in all groups . We conclude that volume-targeted A/C ventilation result ed in more consistent tidal volumes at lower total respiratory rates than IMV or SIMV .  Oxygenation and lung mechanics were not altered by synchronization , possibly due to the volume-targeting strategy . Of the modes studied , A/C , a fully-synchronized mode , may be the most efficient method of mechanical ventilator support in neonates receiving surfactant  for treatment of RDS Objective : Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are , to date , still matter of debate . We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed . Design : Multicenter r and omized control trial . Setting : Three tertiary centers of neonatal intensive care units from December 2004 to December 2007 . Population : Eighty-eight very low birth weight infants complicated by respiratory distress syndrome , without antenatal glucocorticoids , supported by first intention high-frequency oscillatory ventilation ( n = 44 ) or conventional mechanical ventilation ( n = 44 ) . Interventions : All newborns were monitored by st and ard monitoring procedure , including routine laboratory variables , neurologic patterns , and ultrasound imaging . Primary outcomes were : the length of ventilatory support , the need of reintubation , and the length of nasal continuous positive airway pressure support in the postextubation period . Secondary outcomes were : the length of stay in neonatal intensive care unit and in hospital , death before discharge , adverse short- and long-term pulmonary and neonatal outcomes , and the need for a second dose of surfactant and of postnatal glucocorticoid treatment .  Results : High-frequency oscillatory ventilation infants showed a significant lower duration ( p < .001 for all ) of ventilator dependency , lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period . Among secondary outcomes in the high-frequency oscillatory ventilation infants , the need of a second dose of surfactant administration , and the length of stay in the neonatal intensive care unit and in hospital were significantly lower ( p < .05 for all ) . Conclusions : We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support , surfactant therapy , and reintubation , and shortened neonatal intensive care unit and hospital stay , thus reducing unit and hospital costs . These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population , such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids OBJECTIVE To compare the efficacy and safety of volume-controlled ( VC ) ventilation to time-cycled pressure-limited ( TCPL ) ventilation in very low birth weight infants with respiratory distress syndrome ( RDS ) . STUDY DESIGN Newborns weighing between 600 and 1500 g and with a gestational age of 24 to 31 weeks who had RDS were r and omized to receive either VC or TCPL ventilation and treated with a st and ardized protocol . The 2 modalities were compared by determining the time required to achieve a predetermined success criterion , on the basis of either the alveolar-arterial oxygen gradient < 100 mm Hg or the mean airway pressure < 8 cm H(2)O. Secondary outcomes included mortality , duration of mechanical ventilation , and complications commonly associated with ventilation . RESULTS The mean time to reach the success criterion was 23 hours in the VC group versus 33 hours in the TCPL group ( P = .15 ) . This difference was more striking in babies weighing < 1000 g ( 21 versus 58 hours ; P = .03 ) . Mean duration of ventilation with VC  was 255 hours versus 327 hours with TCPL ( P = .60 ) . There were 5 deaths in the VC group and 10 deaths in the TCPL group ( P = .10 ) . The incidence of other complications was similar . CONCLUSION VC ventilation is safe and efficacious in very low birth weight infants and may have advantages when compared with TCPL , especially in smaller infants To compare high-frequency jet ventilation ( HFJV ) with pressure-limited time-cycled conventional ventilation ( CV ) , we r and omized 41 infants with clinical and radiographic evidence of respiratory distress syndrome during the first day of life to receive either HFJV or CV .  St and ardized ventilatory protocol s were used for 48 hours , after which CV was administered to both groups . Despite comparable oxygenation ( arterial/alveolar oxygen tension ratio ) , mean airway pressure was lower in the HFJV group ( 9 + /- 2 vs 13 + /- 2 cm H2O , P less than 0.001 ) , and thus the arterial/alveolar oxygen tension ratio corrected for mean airway pressure was improved in the HFJV group ( P less than 0.05 ) . PaCO2 was lower during HFJV ( 37 + /- 3 vs 42 + /- 3 mm Hg , P less than 0.05 ) despite a comparable peak inspiratory pressure . The incidence of air leaks , progression of intraventricular hemorrhage , and mortality during the 48-hour period did not differ between the two groups . Bronchoscopies in eight infants given HFJV and five given CV revealed no microscopic evidence of necrotizing tracheobronchitis , but one infant given HFJV had evidence of necrotizing tracheitis at autopsy . We conclude that for 48 hours during the acute stage of respiratory distress syndrome , HFJV can maintain adequate gas exchange at lower mean airway pressure than during CV , without an increase in the incidence of side effects OBJECTIVE The objective of this investigation was to determine if high-frequency jet ventilation ( HFJV ) used early in the treatment of premature infants with respiratory distress syndrome was effective in reducing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes . STUDY DESIGN A total of 73 premature infants who met the inclusion criteria ( gestational age of less than 33 weeks , birth weight of more than 500 g , age of less than 24 hours , need for assisted ventilation with peak inspiratory pressure of more than 16 and FIO2 more than 0.30 , and roentgenographic evidence of respiratory distress syndrome ) were r and omized to either conventional ( n = 36 ) or to high-frequency jet  ( n = 37 ) ventilation . Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they could either be extubated or meet crossover criteria . Univariate analyses were initially used to compare the two groups . Stepwise logistic regression was subsequently used to assess whether various factors independently influenced adverse outcomes . RESULTS The two groups of infants were similar in all obstetrical , perinatal , and neonatal demographic characteristics . The mean birth weight and gestational age in the conventional group were 930 g and 26.6 weeks and in the HFJV group , 961 g and 26.9 weeks . The infants were r and omized at similar ages ( 7.1 and 7.3 hours of life , respectively ) . Their prer and omization ventilator setting s and arterial blood gases were nearly identical . There were no differences in pulmonary outcomes ( occurrence of air leaks , need for oxygen or ventilation at 36 weeks postconception ) , and there were no differences in the mean number of days oxygen was required , number of days ventilated , or length of hospital stay . Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leukomalacia ( 10 vs 2 , P = .022 ) or to have a poor outcome ( grade IV hemorrhage , cystic periventricular leukomalacia , or death ) ( 17 vs 7 , P = .016 ) . Logistic regression analysis revealed HFJV to be a significant independent predictor of both cystic periventricular leukomalacia and a poor outcome . The presence of hypocarbia was not an independently significant predictor of adverse outcomes . CONCLUSIONS With the HFJV treatment strategy that we used , use of the high-frequency jet ventilator in the early management of premature infants with respiratory distress syndrome result ed in significantly more adverse outcomes than in those treated with conventional mechanical ventilation OBJECTIVE To evaluate the efficacy of targeted tidal volume ventilation in the treatment of severe neonatal respiratory distress syndrome ( RDS ) . METHODS Eighty-four neonates with severe RDS between June 2008 and January 2010 were r and omly assigned to 3 groups according to the ventilation mode : synchronized intermittent positive pressure ventilation plus volume guarantee ( SIPPV+VG ; n=31 ) , high frequency oscillation ventilation ( HFOV ; n=23 ) and intermittent m and atory ventilation ( IMV ; n=30 ) . The oxygenation status , the duration s of oxygen exposure and ventilation and the incidence of complications were observed . RESULTS The oxygenation status ( P/F and a/APO2 ) in the SIPPV+VG and the HFOV groups was improved significantly 12 hrs after ventilation ( P<0.05 ) . While in the IMV group , the oxygenation status was not improved until 24 hrs after ventilation . The duration s of oxygen exposure and ventilation in the SIPPV+VG and the HFOV groups were shorter than in the IMV group ( P<0.05 ) . The incidences of air leak syndrome and ventilation-associated pneumonia ( VAP ) were lower in the SIPPV+VG and the HFOV groups than in the IMV group ( P<0.05 ) . The incidence of severe intracranial hemorrhage in the HFOV group was higher than in the other two groups ( P<0.05 ) . CONCLUSIONS Compared with IMV , SIPPV+VG and HFOV can improve the oxygenation status more quickly , shorten the ventilation duration and decrease the incidences of air leak syndrome and VAP in neonates with severe RDS OBJECTIVE : To evaluate the feasibility of using the pressure support ventilation with volume guarantee ( PSV-VG ) as an initial ventilatory mode in preterm inf 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective Morbidity and mortality remain high amongst babies ventilated for a respiratory distress syndrome ( RDS ) . Whether newly developed ventilators allowing high frequency ventilation such as high frequency flow interrupted ventilation ( HFFIV ) could decrease the morbidity and the mortality was investigated in a r and omized study . Design Preterm babies weighing ≤1800 g suffering from RDS and ventilated by conventional mechanical ventilation ( CMV )  were r and omized to be further ventilated either by CMV ( group CMV ) or by HFFIV ( group HFFIV ) when peak inspiratory pressure ( PIP ) on CMV was ≥20cmH2O . Setting The study was undertaken in the neonatal intensive care unit of the Erasmus Hospital . Patients 24 patients entered into the investigation and were r and omized but 2 patients were removed from the study because the switch over to HFFIV failed . Eight of the 12 CMV  patients and 5 of the 10 HFFIV  patients completed the study . Measurements and results Clinical variables , blood gas analysis and ventilatory variables were looked at . There were no differences in mortality , in incidence of air leaks and pulmonary complications or in blood gas analysis . Bronchopulmonary dysplasia was not decreased by the use of HFFIV . Conclusion It is concluded that HFFIV  is safe although it offers no concrete advantages over CMV when applied as we did in a low pressure approach We set out to evaluate the impact of volume-targeted synchronized ventilation and conventional intermittent m and atory ventilation ( IMV ) on the early physiologic response to surfactant replacement therapy in neonates with respiratory distress syndrome ( RDS ) . We hypothesized that volume-targeted , patient-triggered synchronized ventilation would stabilize minute ventilation at a lower respiratory rate than that seen during volume-targeted IMV , and that synchronization would improve oxygenation and decrease variation in measured tidal volume ( V(t ) ) . This was a prospect i ve , r and omized study of 30 hospitalized neonates with RDS . Infants were r and omly assigned to volume-targeted ventilation using IMV ( n = 10 ) , synchronized IMV ( SIMV ; n = 10 ) , or assist/control ventilation ( A/C ; n = 10 ) after meeting eligibility requirements and before initial surfactant treatment . Following measurements of arterial blood gases and cardiovascular and respiratory parameters , infants received surfactant . Infants were studied for 6 hr following surfactant treatment . Infants assigned to each mode of ventilation had similar birth weight , gestational age , and Apgar scores at birth , and similar oxygenation indices at r and omization . Three patients were eliminated from final data analysis because of exclusionary conditions unknown at r and omization . Oxygenation improved significantly following surfactant therapy in all groups by 1 hr after surfactant treatment ( P < 0.05 ) . No further improvements occurred with time . Total respiratory rate was lowest ( P < 0.05 ) and variation in tidal volume ( V(t ) ) was least in the A/C group ( P < 0 . 05 ) . Minute ventilation ( V(')(E ) ) , delivered airway pressures , respiratory system mechanics , and hemodynamic parameters were similar in all groups . We conclude that volume-targeted A/C ventilation result ed in more consistent tidal volumes at lower total respiratory rates than IMV or SIMV .  Oxygenation and lung mechanics were not altered by synchronization , possibly due to the volume-targeting strategy . Of the modes studied , A/C , a fully-synchronized mode , may be the most efficient method of mechanical ventilator support in neonates receiving surfactant  for treatment of RDS Objective : Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are , to date , still matter of debate . We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed . Design : Multicenter r and omized control trial . Setting : Three tertiary centers of neonatal intensive care units from December 2004 to December 2007 . Population : Eighty-eight very low birth weight infants complicated by respiratory distress syndrome , without antenatal glucocorticoids , supported by first intention high-frequency oscillatory ventilation ( n = 44 ) or conventional mechanical ventilation ( n = 44 ) . Interventions : All newborns were monitored by st and ard monitoring procedure , including routine laboratory variables , neurologic patterns , and ultrasound imaging . Primary outcomes were : the length of ventilatory support , the need of reintubation , and the length of nasal continuous positive airway pressure support in the postextubation period . Secondary outcomes were : the length of stay in neonatal intensive care unit and in hospital , death before discharge , adverse short- and long-term pulmonary and neonatal outcomes , and the need for a second dose of surfactant and of postnatal glucocorticoid treatment .  Results : High-frequency oscillatory ventilation infants showed a significant lower duration ( p < .001 for all ) of ventilator dependency , lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period . Among secondary outcomes in the high-frequency oscillatory ventilation infants , the need of a second dose of surfactant administration , and the length of stay in the neonatal intensive care unit and in hospital were significantly lower ( p < .05 for all ) . Conclusions : We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support , surfactant therapy , and reintubation , and shortened neonatal intensive care unit and hospital stay , thus reducing unit and hospital costs . These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population , such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids OBJECTIVE To compare the efficacy and safety of volume-controlled ( VC ) ventilation to time-cycled pressure-limited ( TCPL ) ventilation in very low birth weight infants with respiratory distress syndrome ( RDS ) . STUDY DESIGN Newborns weighing between 600 and 1500 g and with a gestational age of 24 to 31 weeks who had RDS were r and omized to receive either VC or TCPL ventilation and treated with a st and ardized protocol . The 2 modalities were compared by determining the time required to achieve a predetermined success criterion , on the basis of either the alveolar-arterial oxygen gradient < 100 mm Hg or the mean airway pressure < 8 cm H(2)O. Secondary outcomes included mortality , duration of mechanical ventilation , and complications commonly associated with ventilation . RESULTS The mean time to reach the success criterion was 23 hours in the VC group versus 33 hours in the TCPL group ( P = .15 ) . This difference was more striking in babies weighing < 1000 g ( 21 versus 58 hours ; P = .03 ) . Mean duration of ventilation with VC  was 255 hours versus 327 hours with TCPL ( P = .60 ) . There were 5 deaths in the VC group and 10 deaths in the TCPL group ( P = .10 ) . The incidence of other complications was similar . CONCLUSION VC ventilation is safe and efficacious in very low birth weight infants and may have advantages when compared with TCPL , especially in smaller infants To compare high-frequency jet ventilation ( HFJV ) with pressure-limited time-cycled conventional ventilation ( CV ) , we r and omized 41 infants with clinical and radiographic evidence of respiratory distress syndrome during the first day of life to receive either HFJV or CV .  St and ardized ventilatory protocol s were used for 48 hours , after which CV was administered to both groups . Despite comparable oxygenation ( arterial/alveolar oxygen tension ratio ) , mean airway pressure was lower in the HFJV group ( 9 + /- 2 vs 13 + /- 2 cm H2O , P less than 0.001 ) , and thus the arterial/alveolar oxygen tension ratio corrected for mean airway pressure was improved in the HFJV group ( P less than 0.05 ) . PaCO2 was lower during HFJV ( 37 + /- 3 vs 42 + /- 3 mm Hg , P less than 0.05 ) despite a comparable peak inspiratory pressure . The incidence of air leaks , progression of intraventricular hemorrhage , and mortality during the 48-hour period did not differ between the two groups . Bronchoscopies in eight infants given HFJV and five given CV revealed no microscopic evidence of necrotizing tracheobronchitis , but one infant given HFJV had evidence of necrotizing tracheitis at autopsy . We conclude that for 48 hours during the acute stage of respiratory distress syndrome , HFJV can maintain adequate gas exchange at lower mean airway pressure than during CV , without an increase in the incidence of side effects OBJECTIVE The objective of this investigation was to determine if high-frequency jet ventilation ( HFJV ) used early in the treatment of premature infants with respiratory distress syndrome was effective in reducing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes . STUDY DESIGN A total of 73 premature infants who met the inclusion criteria ( gestational age of less than 33 weeks , birth weight of more than 500 g , age of less than 24 hours , need for assisted ventilation with peak inspiratory pressure of more than 16 and FIO2 more than 0.30 , and roentgenographic evidence of respiratory distress syndrome ) were r and omized to either conventional ( n = 36 ) or to high-frequency jet  ( n = 37 ) ventilation . Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they could either be extubated or meet crossover criteria . Univariate analyses were initially used to compare the two groups . Stepwise logistic regression was subsequently used to assess whether various factors independently influenced adverse outcomes . RESULTS The two groups of infants were similar in all obstetrical , perinatal , and neonatal demographic characteristics . The mean birth weight and gestational age in the conventional group were 930 g and 26.6 weeks and in the HFJV group , 961 g and 26.9 weeks . The infants were r and omized at similar ages ( 7.1 and 7.3 hours of life , respectively ) . Their prer and omization ventilator setting s and arterial blood gases were nearly identical . There were no differences in pulmonary outcomes ( occurrence of air leaks , need for oxygen or ventilation at 36 weeks postconception ) , and there were no differences in the mean number of days oxygen was required , number of days ventilated , or length of hospital stay . Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leukomalacia ( 10 vs 2 , P = .022 ) or to have a poor outcome ( grade IV hemorrhage , cystic periventricular leukomalacia , or death ) ( 17 vs 7 , P = .016 ) . Logistic regression analysis revealed HFJV to be a significant independent predictor of both cystic periventricular leukomalacia and a poor outcome . The presence of hypocarbia was not an independently significant predictor of adverse outcomes . CONCLUSIONS With the HFJV treatment strategy that we used , use of the high-frequency jet ventilator in the early management of premature infants with respiratory distress syndrome result ed in significantly more adverse outcomes than in those treated with conventional mechanical ventilation OBJECTIVE To evaluate the efficacy of targeted tidal volume ventilation in the treatment of severe neonatal respiratory distress syndrome ( RDS ) . METHODS Eighty-four neonates with severe RDS between June 2008 and January 2010 were r and omly assigned to 3 groups according to the ventilation mode : synchronized intermittent positive pressure ventilation plus volume guarantee ( SIPPV+VG ; n=31 ) , high frequency oscillation ventilation ( HFOV ; n=23 ) and intermittent m and atory ventilation ( IMV ; n=30 ) . The oxygenation status , the duration s of oxygen exposure and ventilation and the incidence of complications were observed . RESULTS The oxygenation status ( P/F and a/APO2 ) in the SIPPV+VG and the HFOV groups was improved significantly 12 hrs after ventilation ( P<0.05 ) . While in the IMV group , the oxygenation status was not improved until 24 hrs after ventilation . The duration s of oxygen exposure and ventilation in the SIPPV+VG and the HFOV groups were shorter than in the IMV group ( P<0.05 ) . The incidences of air leak syndrome and ventilation-associated pneumonia ( VAP ) were lower in the SIPPV+VG and the HFOV groups than in the IMV group ( P<0.05 ) . The incidence of severe intracranial hemorrhage in the HFOV group was higher than in the other two groups ( P<0.05 ) . CONCLUSIONS Compared with IMV , SIPPV+VG and HFOV can improve the oxygenation status more quickly , shorten the ventilation duration and decrease the incidences of air leak syndrome and VAP in neonates with severe RDS OBJECTIVE : To evaluate the feasibility of using the pressure support ventilation with volume guarantee ( PSV-VG ) as an initial ventilatory mode in preterm inf 
    Output:
    