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Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in
D J Henderson-Smart1, T Bhuta, F Cools
1NSW Centre for Perinatal Health Services Research, Queen Elizabeth II Institute for Mothers and Infants, Building DO2, University of Sydney, Sydney, NSW, Australia, 2006. dhs@mail.usyd.edu.au
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
High frequency oscillatory ventilation (HFOV) may reduce chronic lung disease (CLD) in preterm infants when used with a high volume strategy (HVS). However, HFOV may increase risks of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL).
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Respiratory failure in preterm infants is a leading cause of mortality.
- Conventional intermittent positive pressure ventilation (IPPV) can cause lung injury and chronic lung disease (CLD).
- High frequency oscillatory ventilation (HFOV) is a newer ventilation method with potential for reduced lung injury.
Purpose of the Study:
- To evaluate the effectiveness of elective HFOV versus conventional ventilation (CV) in preterm infants.
- To determine if HFOV decreases the incidence of CLD without adverse effects in mechanically ventilated preterm infants with respiratory distress syndrome (RDS).
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searches included major databases (MEDLINE, EMBASE, Oxford Database of Perinatal Trials) and handsearching.
- Data synthesis used relative risk (RR), risk difference (RD), number needed to treat (NNT), and number needed to harm (NNH).
Main Results:
- No significant difference in mortality between HFOV and CV groups.
- HFOV showed trends towards decreased CLD in survivors, but also trends towards increased severe intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL).
- A subgroup analysis using a high volume strategy (HVS) demonstrated significantly lower rates of CLD in survivors with HFOV.
Conclusions:
- The overall meta-analysis was influenced by studies not using HVS or surfactant.
- Studies employing HVS with HFOV showed benefits in short-term CLD measures.
- Further research is needed to clarify the risks and benefits of HFOV, particularly regarding neurodevelopmental outcomes and specific ventilation strategies.