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Meta-Analysis
. 2024 Jul 30;19(7):e0307903.
doi: 10.1371/journal.pone.0307903. eCollection 2024.

Noninvasive high-frequency oscillation ventilation as post- extubation respiratory support in neonates: Systematic review and meta-analysis

Rameshwar Prasad  1 , Bijan Saha  2 , Md Habibullah Sk  2 , Jagdish Prasad Sahoo  3 , Bhupendra Kumar Gupta  4 , Subhash Chandra Shaw  5
Affiliations
Meta-Analysis

Noninvasive high-frequency oscillation ventilation as post- extubation respiratory support in neonates: Systematic review and meta-analysis

Rameshwar Prasad et al. PLoS One. .

Abstract

Introduction: Noninvasive High-Frequency Oscillatory Ventilation (NHFOV) is increasingly being adopted to reduce the need for invasive ventilation after extubation.

Objectives: To evaluate the benefits and harms of NHFOV as post-extubation respiratory support in newborns compared to other non-invasive respiratory support modes.

Material & methods: We included randomized controlled trials comparing NHFOV with other non-invasive modes post-extubation in newborns. Data sources were MEDLINE (via Pubmed), Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, WHO international clinical trials registry platform and Clinical Trial Registry, forward and backward citation search. Methodological quality of studies was assessed by Cochrane's Risk of Bias tool 1.0.

Results: This systematic review included 21 studies and 3294 participants, the majority of whom were preterm. NHFOV compared to nasal continuous positive airway pressure (NCPAP) reduced reintubation within seven days (RR 0.34, 95% CI 0.22 to 0.53) after extubation. It also reduced extubation failure (RR 0.39, 95% CI 0.30 to 0.51) and reintubation within 72 hrs (RR 0.40, 95% CI 0.31 to 0.53), bronchopulmonary dysplasia (RR 0.59, 95% CI 0.37 to 0.94) and pulmonary air leak (RR 0.46, 95% CI 0.27 to 0.79) compared to NCPAP. The rate of reintubation within seven days (RR 0.62, 95% CI 0.18 to 2.14) was similar whereas extubation failure (RR 0.65, 95% CI 0.50 to 0.83) and reintubation (RR 0.68, 95% CI 0.52 to 0.89) within 72 hrs were lower in NHFOV group compared to nasal intermittent positive pressure ventilation. There was no effect on other outcomes. Overall quality of the evidence was low to very low in both comparisons.

Conclusions: NHFOV may reduce the rate of reintubation and extubation failure post-extubation without increasing complications. Majority of the trials were exclusively done in preterm neonates. Further research with high methodological quality is warranted.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of the study selection process.
Fig 2
Fig 2. Forest plot of comparison: NHFOV vs NCPAP, outcome: Reintubation within 7 days of extubation.
Fig 3
Fig 3. Forest plot of comparison: NHFOV vs NCPAP, outcome: Extubation failure within 72 hrs.
Fig 4
Fig 4. Forest plot of comparison: NHFOV vs NIPPV, outcome: Reintubation within 7 days of extubation.
Fig 5
Fig 5. Forest plot of comparison: NHFOV vs NIPPV, outcome: Extubation failure within 72 hrs.
See this image and copyright information in PMC

References

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