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Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in
D J Henderson-Smart1, F Cools, T Bhuta
1Queen Elizabeth II Research Institute, NSW Centre for Perinatal Health Services Research, Building DO2, University of Sydney, Sydney, NSW, Australia, 2006. dhs@mail.usyd.edu.au
The Cochrane Database of Systematic Reviews
|July 20, 2007
Summary
High frequency oscillatory ventilation (HFOV) shows no clear mortality benefit over conventional ventilation (CV) for preterm infants with respiratory distress syndrome (RDS). While HFOV may slightly reduce chronic lung disease (CLD), evidence is inconsistent, and risks like air leaks exist.
Area of Science:
- Neonatal respiratory support
- Mechanical ventilation strategies
- Preterm infant outcomes
Background:
- Respiratory failure in preterm infants due to lung immaturity 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 technique with potential for reduced lung injury.
Purpose of the Study:
- To compare the elective use of HFOV versus conventional ventilation (CV) in preterm infants with respiratory distress syndrome (RDS).
- To assess the impact on chronic lung disease (CLD), mortality, and other prematurity-related complications.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searches included major databases (MEDLINE, EMBASE, Oxford Database of Perinatal Trials).
- Included trials compared HFOV and CV in preterm infants receiving IPPV, initiated early in life.
Main Results:
- No significant difference in mortality at 28-30 days or term equivalent age between HFOV and CV groups.
- Overall reduction in CLD with HFOV was of borderline significance and inconsistent across studies.
- HFOV group had more pulmonary air leaks; some studies indicated short-term neurological risks, though not statistically significant overall. Retinopathy of prematurity was reduced.
Conclusions:
- Elective HFOV does not demonstrate clear advantages over CV as an initial strategy for preterm infants with acute pulmonary dysfunction.
- A potential small reduction in CLD with HFOV is noted, but its significance is weakened by inconsistent findings.
- Future research should focus on high-risk infants, compare specific HFOV/CV strategies, and report long-term neurodevelopmental outcomes.
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