High-frequency oscillatory ventilation versus conventional ventilation for infants with severe pulmonary dysfunction...

Pulmonary disease is a common cause of morbidity and mortality in term and near-term infants. For several decades, conventional ventilation (CV) has been widely used to manage pulmonary dysfunction. High-frequency oscillatory ventilation (HFOV) may prove to be more effective than CV in these infants. However, with recent innovations in CV, it remains unclear whether HFOV is more effective than CV in term or near-term infants with severe pulmonary dysfunction. This is an update of a review previously conducted in 2009.

To determine the effect of HFOV compared with CV on mortality and morbidity in infants born at 35 weeks' gestation or more with severe respiratory failure due to lung disease requiring mechanical ventilation.

We searched CENTRAL, MEDLINE, Embase, trial registries, and conference abstracts in May 2024. We also checked the references of included studies and related literature for eligible studies.

We included randomized and quasi-randomized trials comparing HFOV to CV in infants born at 35 weeks' gestation or more with severe pulmonary dysfunction within 28 days of life.

Our outcomes included failed therapy on assigned mode of ventilation at any time point; mortality at any time during hospitalization or in the first year; neurodevelopmental outcomes at two years of age or later childhood (such as cerebral palsy, cognitive, behavioral, hearing, and vision outcomes); the combined outcome of death or neurodevelopmental impairment in childhood; pulmonary air leak during hospitalization; and duration of mechanical ventilation (days).

We assessed risk of bias in the included studies using Cochrane's RoB 1 tool.

We synthesized the results of each outcome in meta-analysis using a fixed-effect model. For continuous outcome measures, we reported mean differences (MDs) with 95% confidence intervals (CIs). For dichotomous outcomes, we reported risk ratios (RRs) with 95% CIs. We used GRADE to assess the certainty of evidence for the prespecified outcomes.

We included three studies enrolling a total of 368 near-term or term infants of less than 28 days with severe pulmonary dysfunction.

We are very uncertain about the effect of HFOV on failed therapy at any time point (RR 1.19, 95% CI 0.86 to 1.64; 3 studies, 368 infants; very low-certainty evidence). HFOV may increase mortality at any time during hospitalization or in the first year (RR 1.47, 95% CI 0.92 to 2.34; 3 studies, 368 infants; low-certainty evidence). Neurodevelopmental at two years of age or more and the combined outcome of death or neurodevelopmental impairment were not reported in any of the included studies. The evidence is very uncertain about the effect of HFOV on pulmonary air leak during hospitalization (RR 0.91, 95% CI 0.33 to 2.54; 2 studies, 197 infants; very low-certainty evidence) and duration of mechanical ventilation (days) (MD 0.70, 95% CI -0.97 to 2.37; 1 study, 112 infants; very low-certainty evidence). The risk of bias was generally low, aside from lack of blinding of participants and personnel and outcome assessment. We therefore judged the risk of detection bias to be high for all outcomes except for the objective outcome (i.e. mortality), which we judged to be at low risk of bias.

Based on the available evidence, we are very uncertain about the effects of HFOV on failed therapy. HFOV may increase mortality. We are unable to support or refute the use of HFOV in near-term or term infants with severe pulmonary dysfunction. Further randomized controlled trials are needed, stratified by disease and including long-term neurodevelopmental outcomes. There is also a need for studies comparing newer forms of CV and HFOV.

This Cochrane review had no dedicated funding.

Protocol (1997): unavailable Original review, first version (2001): https://doi.org/10.1002/14651858.CD002974 First update version (2009): https://doi.org/10.1002/14651858.CD002974.pub2.