Meta-analysis of elective high frequency ventilation in preterm infants with respiratory distress syndrome
Department of
Neonatology, H3-150 Emma Children's Hospital / Academic
Medical Centre PO Box 22660 1100 DD Amsterdam
The Netherlands
Correspondence to: Dr M Offringa. Email: M.Offringa{at}amc.uva.nl
Accepted 19 August 1998
AIM
To summarise the evidence on the
efficacy of elective high frequency ventilation compared with
conventional ventilation in preterm infants with respiratory distress syndrome.
METHODSA 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.
RESULTSTen studies (a total number of 1345 preterm infants) were considered for data synthesis. No difference in
mortality at 28 or 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).
CONCLUSIONSAlthough 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.
© 1999 by Archives of Disease in Childhood
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