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. 1999 Jan;80(1):F15–F20. doi: 10.1136/fn.80.1.f15

Meta-analysis of elective high frequency ventilation in preterm infants with respiratory distress syndrome

F Cools, M Offringa
PMCID: PMC1720870  PMID: 10325805

Abstract

AIM—To summarise the evidence on the efficacy of elective high frequency ventilation compared with conventional ventilation in preterm infants with respiratory distress syndrome.
METHODS—A search from 1987 onwards was made on Embase, Medline, and the Cochrane Library. A questionnaire was also circulated during an international meeting on high frequency ventilation. To be included in the data synthesis, studies had to be randomised controlled trials comparing elective high frequency ventilation with conventional ventilation in preterm infants with respiratory failure due to respiratory distress syndrome; indices of mortality, chronic pulmonary morbidity, and other clinically relevant outcomes were compared. Studies were assessed for methodological validity according to explicit criteria.
RESULTS—Ten studies (a total number of 1345 preterm infants) were considered for data synthesis. No difference in mortality at 28or 30 days, nor in oxygen dependency at 28 days was found between both types of ventilation. Reduced oxygen dependency at the postconceptional age of 36 weeks (RR 0.50, 95% CI 0.32-0.78) was found, but so was an increase in grades 3 and 4 intraventricular haemorrhage (IVH) (RR 1.31, 95% CI 1.04-1.66). Those studies using a high lung volume ventilatory strategy showed a significant decrease in oxygen dependency at the postconceptional age of 36 weeks (RR 0.44, 95% CI 0.27-0.73), but no increase in severe IVH (RR 0.78,95% CI 0.45-1.37).
CONCLUSIONS—Although high frequency ventilation reduces chronic lung disease, it seems to increase the risk of severe IVH. These results are dominated by an early study where the absence of benefit on pulmonary outcomes, and the increase in adverse neurological events, could be related to the low volume ventilatory strategy used. Recent studies, using a high lung volume approach, show better pulmonary outcomes without any increase in intracranial morbidity. Still, uncertainty remains about long term pulmonary and neurodevelopmental outcome.



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Selected References

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  1. Bohn D. J., Miyasaka K., Marchak B. E., Thompson W. K., Froese A. B., Bryan A. C. Ventilation by high-frequency oscillation. J Appl Physiol Respir Environ Exerc Physiol. 1980 Apr;48(4):710–716. doi: 10.1152/jappl.1980.48.4.710. [DOI] [PubMed] [Google Scholar]
  2. Bryan A. C., Froese A. B. Reflections on the HIFI trial. Pediatrics. 1991 Apr;87(4):565–567. [PubMed] [Google Scholar]
  3. Carlo W. A., Chatburn R. L., Martin R. J. Randomized trial of high-frequency jet ventilation versus conventional ventilation in respiratory distress syndrome. J Pediatr. 1987 Feb;110(2):275–282. doi: 10.1016/s0022-3476(87)80173-7. [DOI] [PubMed] [Google Scholar]
  4. Carlo W. A., Siner B., Chatburn R. L., Robertson S., Martin R. J. Early randomized intervention with high-frequency jet ventilation in respiratory distress syndrome. J Pediatr. 1990 Nov;117(5):765–770. doi: 10.1016/s0022-3476(05)83341-4. [DOI] [PubMed] [Google Scholar]
  5. Clark R. H., Gerstmann D. R., Null D. M., Jr, deLemos R. A. Prospective randomized comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome. Pediatrics. 1992 Jan;89(1):5–12. [PubMed] [Google Scholar]
  6. Clark R. H., Yoder B. A., Sell M. S. Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr. 1994 Mar;124(3):447–454. doi: 10.1016/s0022-3476(94)70374-4. [DOI] [PubMed] [Google Scholar]
  7. DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177–188. doi: 10.1016/0197-2456(86)90046-2. [DOI] [PubMed] [Google Scholar]
  8. Engle W. A., Yoder M. C., Andreoli S. P., Darragh R. K., Langefeld C. D., Hui S. L. Controlled prospective randomized comparison of high-frequency jet ventilation and conventional ventilation in neonates with respiratory failure and persistent pulmonary hypertension. J Perinatol. 1997 Jan-Feb;17(1):3–9. [PubMed] [Google Scholar]
  9. Fleiss J. L. The statistical basis of meta-analysis. Stat Methods Med Res. 1993;2(2):121–145. doi: 10.1177/096228029300200202. [DOI] [PubMed] [Google Scholar]
  10. Froese A. B., Butler P. O., Fletcher W. A., Byford L. J. High-frequency oscillatory ventilation in premature infants with respiratory failure: a preliminary report. Anesth Analg. 1987 Sep;66(9):814–824. [PubMed] [Google Scholar]
  11. Fujimoto S., Togari H., Yamaguchi N., Mizutani F., Suzuki S., Sobajima H. Hypocarbia and cystic periventricular leukomalacia in premature infants. Arch Dis Child. 1994 Sep;71(2):F107–F110. doi: 10.1136/fn.71.2.f107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gerstmann D. R., Minton S. D., Stoddard R. A., Meredith K. S., Monaco F., Bertrand J. M., Battisti O., Langhendries J. P., Francois A., Clark R. H. The Provo multicenter early high-frequency oscillatory ventilation trial: improved pulmonary and clinical outcome in respiratory distress syndrome. Pediatrics. 1996 Dec;98(6 Pt 1):1044–1057. [PubMed] [Google Scholar]
  13. Hack M., Horbar J. D., Malloy M. H., Tyson J. E., Wright E., Wright L. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network. Pediatrics. 1991 May;87(5):587–597. [PubMed] [Google Scholar]
  14. Jackson J. C., Truog W. E., Standaert T. A., Murphy J. H., Juul S. E., Chi E. Y., Hildebrandt J., Hodson W. A. Reduction in lung injury after combined surfactant and high-frequency ventilation. Am J Respir Crit Care Med. 1994 Aug;150(2):534–539. doi: 10.1164/ajrccm.150.2.8049842. [DOI] [PubMed] [Google Scholar]
  15. Keszler M., Donn S. M., Bucciarelli R. L., Alverson D. C., Hart M., Lunyong V., Modanlou H. D., Noguchi A., Pearlman S. A., Puri A. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr. 1991 Jul;119(1 Pt 1):85–93. doi: 10.1016/s0022-3476(05)81046-7. [DOI] [PubMed] [Google Scholar]
  16. Keszler M., Modanlou H. D., Brudno D. S., Clark F. I., Cohen R. S., Ryan R. M., Kaneta M. K., Davis J. M. Multicenter controlled clinical trial of high-frequency jet ventilation in preterm infants with uncomplicated respiratory distress syndrome. Pediatrics. 1997 Oct;100(4):593–599. doi: 10.1542/peds.100.4.593. [DOI] [PubMed] [Google Scholar]
  17. Kinsella J. P., Gerstmann D. R., Clark R. H., Null D. M., Jr, Morrow W. R., Taylor A. F., deLemos R. A. High-frequency oscillatory ventilation versus intermittent mandatory ventilation: early hemodynamic effects in the premature baboon with hyaline membrane disease. Pediatr Res. 1991 Feb;29(2):160–166. doi: 10.1203/00006450-199102000-00012. [DOI] [PubMed] [Google Scholar]
  18. Laubscher B., van Melle G., Fawer C. L., Sekarski N., Calame A. Haemodynamic changes during high frequency oscillation for respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed. 1996 May;74(3):F172–F176. doi: 10.1136/fn.74.3.f172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Marlow N. High frequency ventilation and respiratory distress syndrome: do we have an answer? Arch Dis Child Fetal Neonatal Ed. 1998 Jan;78(1):F1–F2. doi: 10.1136/fn.78.1.f1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. McCulloch P. R., Forkert P. G., Froese A. B. Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis. 1988 May;137(5):1185–1192. doi: 10.1164/ajrccm/137.5.1185. [DOI] [PubMed] [Google Scholar]
  21. Meredith K. S., deLemos R. A., Coalson J. J., King R. J., Gerstmann D. R., Kumar R., Kuehl T. J., Winter D. C., Taylor A., Clark R. H. Role of lung injury in the pathogenesis of hyaline membrane disease in premature baboons. J Appl Physiol (1985) 1989 May;66(5):2150–2158. doi: 10.1152/jappl.1989.66.5.2150. [DOI] [PubMed] [Google Scholar]
  22. Ogawa Y., Miyasaka K., Kawano T., Imura S., Inukai K., Okuyama K., Oguchi K., Togari H., Nishida H., Mishina J. A multicenter randomized trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure. Early Hum Dev. 1993 Feb;32(1):1–10. doi: 10.1016/0378-3782(93)90088-c. [DOI] [PubMed] [Google Scholar]
  23. Pardou A., Vermeylen D., Muller M. F., Detemmerman D. High-frequency ventilation and conventional mechanical ventilation in newborn babies with respiratory distress syndrome: a prospective, randomized trial. Intensive Care Med. 1993;19(7):406–410. doi: 10.1007/BF01724881. [DOI] [PubMed] [Google Scholar]
  24. Rettwitz-Volk W., Veldman A., Roth B., Vierzig A., Kachel W., Varnholt V., Schlösser R., von Loewenich V. A prospective, randomized, multicenter trial of high-frequency oscillatory ventilation compared with conventional ventilation in preterm infants with respiratory distress syndrome receiving surfactant. J Pediatr. 1998 Feb;132(2):249–254. doi: 10.1016/s0022-3476(98)70440-8. [DOI] [PubMed] [Google Scholar]
  25. Schlösser R. L., Rettwitz-Volk W., Allendorf A., von Loewenich V. Hämodynamische Auswirkungen der hochfrequenten Oscillationsbeatmung bei Früh- und reifen Neugeborenen. Klin Padiatr. 1994 Nov-Dec;206(6):421–424. doi: 10.1055/s-2008-1046642. [DOI] [PubMed] [Google Scholar]
  26. Taskar V., John J., Evander E., Robertson B., Jonson B. Surfactant dysfunction makes lungs vulnerable to repetitive collapse and reexpansion. Am J Respir Crit Care Med. 1997 Jan;155(1):313–320. doi: 10.1164/ajrccm.155.1.9001330. [DOI] [PubMed] [Google Scholar]
  27. Thome U., Götze-Speer B., Speer C. P., Pohlandt F. Comparison of pulmonary inflammatory mediators in preterm infants treated with intermittent positive pressure ventilation or high frequency oscillatory ventilation. Pediatr Res. 1998 Sep;44(3):330–337. doi: 10.1203/00006450-199809000-00011. [DOI] [PubMed] [Google Scholar]
  28. Wiswell T. E., Graziani L. J., Kornhauser M. S., Cullen J., Merton D. A., McKee L., Spitzer A. R. High-frequency jet ventilation in the early management of respiratory distress syndrome is associated with a greater risk for adverse outcomes. Pediatrics. 1996 Dec;98(6 Pt 1):1035–1043. [PubMed] [Google Scholar]
  29. Wiswell T. E., Graziani L. J., Kornhauser M. S., Stanley C., Merton D. A., McKee L., Spitzer A. R. Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation. Pediatrics. 1996 Nov;98(5):918–924. [PubMed] [Google Scholar]

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