Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data.

Pubmed ID: 20552718

Journal: Lancet (London, England)

Publication Date: June 12, 2010

MeSH Terms: Humans, Infant, Newborn, Infant, Premature, Bronchopulmonary Dysplasia, High-Frequency Ventilation, Infant, Premature, Diseases, Positive-Pressure Respiration, Respiratory Distress Syndrome, Newborn

Authors: Cools F, Cools F, Askie LM, Askie LM, Offringa M, Offringa M, Asselin JM, Asselin JM, Calvert SA, Calvert SA, Courtney SE, Courtney SE, Dani C, Dani C, Durand DJ, Durand DJ, Gerstmann DR, Gerstmann DR, Henderson-Smart DJ, Henderson-Smart DJ, Marlow N, Marlow N, Peacock JL, Peacock JL, Pillow JJ, Pillow JJ, Soll RF, Soll RF, Thome UH, Thome UH, Truffert P, Truffert P, Schreiber MD, Schreiber MD, Van Reempts P, Van Reempts P, Vendettuoli V, Vendettuoli V, Vento G, Vento G, Clark RH, Tamura M, Fischer D, Plavka R, Finer NN, Craft AP, Lista G, Stewart L, Bollen C, Thornton C, Lei W

Cite As: Cools F, Askie LM, Offringa M, Asselin JM, Calvert SA, Courtney SE, Dani C, Durand DJ, Gerstmann DR, Henderson-Smart DJ, Marlow N, Peacock JL, Pillow JJ, Soll RF, Thome UH, Truffert P, Schreiber MD, Van Reempts P, Vendettuoli V, Vento G, PreVILIG collaboration. Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data. Lancet 2010 Jun 12;375(9731):2082-91.

Studies:

Abstract

BACKGROUND: Population and study design heterogeneity has confounded previous meta-analyses, leading to uncertainty about effectiveness and safety of elective high-frequency oscillatory ventilation (HFOV) in preterm infants. We assessed effectiveness of elective HFOV versus conventional ventilation in this group. METHODS: We did a systematic review and meta-analysis of individual patients' data from 3229 participants in ten randomised controlled trials, with the primary outcomes of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age, death or severe adverse neurological event, or any of these outcomes. FINDINGS: For infants ventilated with HFOV, the relative risk of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age was 0.95 (95% CI 0.88-1.03), of death or severe adverse neurological event 1.00 (0.88-1.13), or any of these outcomes 0.98 (0.91-1.05). No subgroup of infants (eg, gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids) benefited more or less from HFOV. Ventilator type or ventilation strategy did not change the overall treatment effect. INTERPRETATION: HFOV seems equally effective to conventional ventilation in preterm infants. Our results do not support selection of preterm infants for HFOV on the basis of gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids. FUNDING: Nestlé Belgium, Belgian Red Cross, and Dräger International.