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. 2000;1998(2):CD000438.
doi: 10.1002/14651858.CD000438.

Rescue high frequency oscillatory ventilation versus conventional ventilation for pulmonary dysfunction in preterm infants

T Bhuta  1 , D J Henderson-Smart
Affiliations

Rescue high frequency oscillatory ventilation versus conventional ventilation for pulmonary dysfunction in preterm infants

T Bhuta et al. Cochrane Database Syst Rev. 2000.

Abstract

Background: This section is under preparation and will be included in the next issue.

Objectives: Experimental studies suggest that high frequency oscillatory ventilation (HFOV) reduces pulmonary injury during mechanical ventilation. The main objective of this review is to test the hypothesis that by use of HFOV as compared to conventional ventilation (CV) it may be possible to rescue preterm infants with very severe lung disease and so at high risk of pulmonary air leak (PAL), without adverse effects.

Search strategy: A search was carried out for all randomized controlled trials from MEDLINE using the MeSH and text terms, "high frequency ventilation", "high frequency oscillatory ventilation", " oscillatory ventilation" from the years 1980 to 1997. EMBASE, the Oxford Database of Perinatal Trials and trials identified by the Neonatal Review Group of the Cochrane Collaboration were also reviewed. Information was also sought from experts in the field, cross references from studies and proceedings of recent meetings.

Selection criteria: Randomized controlled trials of HFOV vs CV as rescue therapy in preterm infants with severe pulmonary dysfunction.

Data collection and analysis: The standard review method of the Neonatal Review Group was used. This includes independent quality assessment and data extraction by the second author. Relative risk (RR), risk difference (RD) and number needed to treat (NNT) were used.

Main results: Only one trial was found and this showed a reduction in any new pulmonary air leak (PAL) [RR 0.73 (0.55,0.96), RD -0.174 (-0.321,-0.027)]. The number of infants that need to be treated (NNT) to prevent one infant having any PAL is six (95% CI 3, 37). There is no difference in the rate of PIE or of gross pulmonary air leak, such as pneumomediastinum or pneumothorax. Mortality and the use of IPPV at 30 days was similar in the HFOV and CV groups. The rate of intraventricular hemorrhage (IVH) of any grade is increased in infants treated with HFOV, RR 1.77 (1.06,2.96), RD 0.156 (0.020, 0. 291). Thus for every six infants (95% CI 3, 50) given rescue HFOV, one IVH of any grade is caused. There is a stronger but non-significant trend towards an increase in the more severe grades 3 or 4 IVH.

Reviewer's conclusions: There is insufficient information on the use of rescue HFOV to make recommendations for practice. The small amount of data that exists suggest that harm might outweigh any benefit. Any future use of HFOV as rescue therapy for preterm infants with severe RDS should be within randomized controlled trials and address important outcomes such as longer term pulmonary and neurological function.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Rescue HFOV vs CV in preterm infants, Outcome 1 Any new PAL among infants examined.
1.2
1.2. Analysis
Comparison 1 Rescue HFOV vs CV in preterm infants, Outcome 2 New PIE among infants examined.
1.3
1.3. Analysis
Comparison 1 Rescue HFOV vs CV in preterm infants, Outcome 3 New gross PAL among infants examined.
1.4
1.4. Analysis
Comparison 1 Rescue HFOV vs CV in preterm infants, Outcome 4 Death by 30 days.
1.5
1.5. Analysis
Comparison 1 Rescue HFOV vs CV in preterm infants, Outcome 5 IPPV at 30 days.
1.6
1.6. Analysis
Comparison 1 Rescue HFOV vs CV in preterm infants, Outcome 6 Death or IPPV at 30 days.
1.7
1.7. Analysis
Comparison 1 Rescue HFOV vs CV in preterm infants, Outcome 7 Any IVH among infants examined.
1.8
1.8. Analysis
Comparison 1 Rescue HFOV vs CV in preterm infants, Outcome 8 Grade 3 or 4 IVH among infants examined.
See this image and copyright information in PMC

References

References to studies included in this review

HIFO 1993 {published data only}
    1. HIFO Study Group. Randomized study of high‐frequency oscillatory ventilation in infants with severe respiratory distress syndrome. Journal of Pediatrics 1993;122:609‐19. - PubMed

Additional references

Bhuta 1998a
    1. Bhuta T, Henderson‐Smart DJ. Elective high frequency jet ventilation vs conventional ventilation in preterm infants mechanically ventilated for respiratory distress syndrome. Cochrane Database of Systematic Reviews 1998, Issue 2. - PMC - PubMed
Bhuta 2006
    1. Bhuta T, Clark RH, Henderson‐Smart DJ. Rescue high frequency oscillatory ventilation vs conventional ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database of Systematic Reviews 2006, Issue 1. - PubMed
Clark 1986
    1. Clark RH, Gerstmann DR, Null DM, Yoder BA, Cornish JD, Glasier CM, et al. Pulmonary interstial emphysema treated by high‐frequency oscillatory ventilation. Critical Care Medicine 1986;14:926‐30. - PubMed
deLemos 1987
    1. deLemos RA, Coalson JJ, Gerstmann DR, Null DM Jr, Ackerman NB, Escobedo MB, et al. Ventilatory management of infant baboons with hyaline membrane disease; the use of high frequency ventilation. Pediatric Research 1987;21:594‐602. - PubMed
Gaylord 1985
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Gerstmann 1988
    1. Gerstmann DR, deLemos RA, Coalson JJ, Clark RH, Wiswell TE, Winter DC, et al. Influence of ventilatory technique on pulmonary baroinjury in baboons with hyaline membrane disease. Pediatric Pulmonology 1988;5:82‐91. - PubMed
Henderson‐Smart 2003
    1. Henderson‐Smart DJ, Bhuta T, Cools F, Offringa M. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database of Systematic Reviews 2003, Issue 4. - PubMed
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Truog 1984
    1. Truog WE, Standaert TA, Murphy JH, Woodrum DE, Hodson WA. Effects of prolonged high frequency oscillatory ventilation in premature primates with experimental hyaline membrane disease. American Review of Respiratory Disease 1984;130:76‐80. - PubMed

References to other published versions of this review

Bhuta 1998
    1. Bhuta T, Henderson‐Smart DJ. Rescue high frequency oscillatory ventilation versus conventional ventilation for pulmonary dysfunction in preterm infants. Cochrane Database of Systematic Reviews 1998, Issue 1. - PMC - PubMed
Bhuta 2003
    1. Bhuta T, Henderson‐Smart DJ. Rescue high frequency oscillatory ventilation versus conventional ventilation for pulmonary dysfunction in preterm infants. Cochrane Database of Systematic Reviews 2003, Issue 1. - PMC - PubMed
Bhuta 2004
    1. Bhuta T, Henderson‐Smart DJ. Rescue high frequency oscillatory ventilation versus conventional ventilation for pulmonary dysfunction in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. - PMC - PubMed

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