High frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in respiratory distress syndrome.

First, out of 296 infants of respiratory distress syndrome (RDS) requiring continuous positive airway pressure (CPAP), a total of 150 infants required intubation for invasive ventilation and another 53 infants requiring intubation couldn’t be randomized due to nonavailability of designated ventilator. This means that there was a CPAP failure in 69% of the cases. Studies from India itself had shown a much lower CPAP failure rate of around 25 to 40% despite the use of surfactant in selected cases [2, 3]. This high failure rate of CPAP raises its own set of issues: how accurately was the definition of respiratory distress syndrome (RDS) being applied? What is the policy for surfactant administration in the unit? Are these findings generalizable to settings where the rate of CPAP failure is almost half?