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Rescue high frequency oscillatory ventilation versus conventional ventilation for pulmonary dysfunction in preterm
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 pulmonary air leak in preterm infants but increases intraventricular hemorrhage risk. More research is needed to determine if HFOV benefits outweigh harms for severe lung disease.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Experimental studies suggest high frequency oscillatory ventilation (HFOV) can mitigate pulmonary injury during mechanical ventilation.
- Preterm infants with severe lung disease face a high risk of pulmonary air leak (PAL).
Purpose of the Study:
- To evaluate the efficacy of HFOV versus conventional ventilation (CV) as a rescue therapy for preterm infants with severe lung disease.
- To determine if HFOV reduces the incidence of pulmonary air leak (PAL) without adverse effects.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) from 1980-1997 using MEDLINE, EMBASE, and other databases.
- Searched for RCTs comparing HFOV and CV as rescue therapy in preterm infants with severe pulmonary dysfunction.
- Data extraction and quality assessment by independent reviewers; analysis using relative risk (RR), risk difference (RD), and number needed to treat (NNT).
Main Results:
- One RCT found HFOV reduced any new pulmonary air leak (PAL) (RR 0.73).
- HFOV did not significantly alter rates of other pulmonary air leaks or mortality at 30 days.
- HFOV use was associated with an increased risk of any-grade intraventricular hemorrhage (IVH) (RR 1.77).
Conclusions:
- Insufficient evidence exists to recommend rescue HFOV for preterm infants with severe lung disease.
- Current data suggest potential harms, such as increased IVH risk, may outweigh benefits.
- Future research should focus on long-term pulmonary and neurological outcomes in RCTs evaluating HFOV.