High-frequency oscillatory ventilation in children: A systematic review and meta-analysis

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation

Background:

• High-frequency oscillatory ventilation (HFOV) is an alternative to conventional mechanical ventilation (CMV) for pediatric patients.
• HFOV is proposed to mitigate ventilator-induced lung injuries and enhance clinical outcomes.
• This study investigates HFOV's efficacy in pediatric hypoxemic respiratory failure.

Purpose of the Study:

• To compare the effects of HFOV versus CMV in pediatric patients with hypoxemic respiratory failure.
• To evaluate HFOV's impact on mortality, ventilation duration, treatment failure, and barotrauma.
• To synthesize current evidence on HFOV use in pediatric respiratory distress.

Main Methods:

• A systematic literature search identified studies published before December 2020.
• Included studies were randomized controlled trials (RCTs) or observational studies of pediatric patients (28 days to 18 years).
• Meta-analyses used random-effects models to pool data from 11 studies (2605 cases).

Main Results:

• No significant difference in mortality was observed between HFOV and CMV (RR, 0.93; 95% CI, 0.72 to 1.20).
• Clinically significant harm or benefit for HFOV could not be excluded.
• No significant differences were found in mechanical ventilation duration, treatment failure, or barotrauma incidence.

Conclusions:

• Current evidence is insufficient to establish HFOV's superiority over CMV for pediatric hypoxemic respiratory failure.
• Further high-quality studies are required to define the role of HFOV in this patient population.
• The findings highlight the need for more research to guide clinical practice regarding HFOV in children.