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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
|January 22, 2003
Summary
High frequency oscillatory ventilation (HFOV) did not significantly reduce mortality in preterm infants. While HFOV showed a modest decrease in chronic lung disease (CLD), results were inconsistent, warranting further research in high-risk infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Respiratory failure in preterm infants is a leading cause of mortality.
- 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 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 CLD without causing adverse effects.
- To assess the impact of HFOV on mortality and neurodevelopmental outcomes.
Main Methods:
- Meta-analysis of ten randomized controlled trials comparing HFOV and CV in preterm infants.
- Searches conducted across major databases including MEDLINE and EMBASE, updated in October 2002.
- Data extraction and analysis included relative risk (RR), risk difference (RD), number needed to treat (NNT), and number needed to harm (NNH).
Main Results:
- HFOV showed no significant effect on mortality at 28-30 days or term equivalent age.
- A significant reduction in CLD was observed in survivors with HFOV, though the effect was modest and inconsistent (NNT 17).
- HFOV significantly reduced the combined outcome of death or CLD, but with a large NNT (20) and inconsistency across studies.
Conclusions:
- Strong evidence indicates HFOV does not significantly impact mortality in preterm infants.
- The modest reduction in CLD with HFOV is supported by weaker evidence due to inconsistencies.
- Future trials should focus on extremely preterm infants at high risk for CLD and investigate different HFOV strategies.