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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
|October 30, 2003
Summary
High frequency oscillatory ventilation (HFOV) did not significantly decrease mortality or chronic lung disease (CLD) in preterm infants compared to conventional ventilation (CV). Some studies indicated potential short-term neurological risks with HFOV, warranting further investigation.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Respiratory failure in preterm infants due to lung immaturity 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 method that may reduce lung injury compared to conventional IPPV.
Purpose of the Study:
- To determine if elective high frequency oscillatory ventilation (HFOV) reduces chronic lung disease (CLD) in preterm infants compared to conventional ventilation (CV).
- To assess adverse effects associated with HFOV in this population.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials comparing HFOV and CV in preterm infants requiring IPPV.
- Searches included major databases and were updated in May 2003.
- Data extraction and quality assessment were performed independently; effects were analyzed using relative risk and risk difference.
Main Results:
- Eleven trials involving 3,275 infants showed no significant difference in mortality rates between HFOV and CV groups.
- The effect of HFOV on chronic lung disease (CLD) in survivors was inconsistent and not statistically significant overall.
- Some studies reported short-term neurological morbidities with HFOV, particularly in subgroups not using a high volume strategy, but these were not statistically significant overall.
Conclusions:
- Elective HFOV as an initial strategy for preterm infants with acute pulmonary dysfunction does not offer clear advantages over CV.
- There is no significant reduction in mortality, and the potential benefit for CLD is uncertain due to inconsistent findings.
- Further research is needed to evaluate long-term pulmonary and neurodevelopmental outcomes, especially in extremely preterm infants at high risk for CLD.