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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@perinatal.usyd.edu.au
The Cochrane Database of Systematic Reviews
|November 1, 2001
Summary
High frequency oscillatory ventilation (HFOV) may reduce chronic lung disease (CLD) in preterm infants but increases risks of pulmonary air leak and severe intraventricular hemorrhage (IVH). Routine use is not recommended until safety concerns are addressed.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Clinical Trials and Meta-Analysis
Background:
- Respiratory failure in preterm infants due to lung immaturity is a significant cause of mortality.
- Conventional intermittent positive pressure ventilation (IPPV) can cause lung injury and chronic lung disease (CLD).
- High frequency oscillatory ventilation (HFOV) is an alternative ventilation method with potential for reduced lung injury.
Purpose of the Study:
- To evaluate the efficacy of elective high frequency oscillatory ventilation (HFOV) versus conventional ventilation (CV) in preterm infants with respiratory distress syndrome (RDS).
- To determine if HFOV decreases the incidence of chronic lung disease (CLD) without causing adverse effects.
Main Methods:
- Systematic review and meta-analysis of eight randomized controlled trials comparing HFOV and CV in preterm infants.
- Data extraction and quality assessment by independent reviewers.
- Synthesis of data using 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 a significant reduction in CLD in survivors at 36-37 weeks postmenstrual age (RR 0.73).
- HFOV was associated with increased severe intraventricular hemorrhage (IVH) and pulmonary air leak syndrome (RR 1.19). Neurodevelopmental follow-up showed poorer outcomes in the HFOV group (RR 1.26).
Conclusions:
- The potential benefits of HFOV in reducing CLD are currently outweighed by increased risks of pulmonary air leak and severe IVH.
- HFOV is not recommended for routine mechanical ventilation in preterm infants with RDS until safety concerns are resolved.
- Future research should focus on very preterm infants at high risk for CLD, stratify by gestational age, and assess long-term pulmonary and neurodevelopmental outcomes.