High-frequency oscillatory ventilation (HFOV) for preterm babies gives outcomes that are no better or worse than conventional ventilation, according to a study of ventilation strategies in high-income countries. Differences in studied populations and study design has made meta-analyses of ventilation studies difficult, leading to uncertainty about effectiveness and safety of elective HFOV in preterm infants. In this [removed]study[/removed], published in the Lancet, the authors of those trials re-assessed the original data, making a new meta-analysis possible.
With HFOV, the lungs are continuously inflated and “oscillate” at a very high rate (600 to 900 per minute) using very small volume changes. Conventional ventilation mimics spontaneous respiration with repeated inflation-deflation of the lungs at a physiological rate of 30 to 60 breaths per minute.
The study looked at 3,229 participants in 10 randomized controlled trials with primary outcomes being death or bronchopulmonary dysplasia at 36 weeks’ postmenstrual age, death or severe adverse neurological event, or any of these outcomes. The authors found no difference in any of these outcomes between the two ventilation techniques, even when infants were categorized by gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroid treatment. Nor did the ventilator type or strategy have any effect on treatment outcome.
“Our meta-analysis of individual patient data suggests that elective HFOV in preterm infants, compared with conventional ventilation, is equally effective in prevention of bronchopulmonary dysplasia without being associated with increased mortality or brain damage,” say the authors.