Key messages
-
It is very unclear whether the use of high-frequency oscillatory ventilation (HFOV) is better than conventional ventilation at reducing treatment failure, death, or complications in babies with severe lung dysfunction.
-
Additional, well-designed studies are needed looking at the effectiveness of HFOV compared to conventional ventilation in term or near-term infants (babies born after a pregnancy of at or near nine months).
What is severe lung disease, and how is it treated?
Severe lung problems in newborn infants are serious and can lead to lung failure, where the body is unable to get enough oxygen and remove carbon dioxide, or even death. Treatment often involves mechanical ventilation. In some cases, additional therapies such as a heart-lung machine (known as extracorporeal membrane oxygenation), or a type of inhaled medical gas (inhaled nitric oxide), may be required to support breathing function.
What is conventional ventilation?
Conventional ventilation is a type of mechanical ventilation used in babies whose lung disease is severe. It is used to deliver breaths to the baby's lungs. It can operate in several modes by controlling either the pressure or the volume that is delivered. The breathing rates used are typically from 30 to 80 breaths per minute.
What is high-frequency oscillatory ventilation?
High-frequency oscillatory ventilation (HFOV) is another type of mechanical ventilation. Very fast and small breaths are delivered to the lungs at rates of approximately 300 to 900 times per minute.
What did we want to find out?
We wanted to find out whether HFOV is more effective than conventional ventilation in improving outcomes and reducing complications, including death, in near-term and term infants (babies born after a pregnancy of at or near nine months) with severe lung problems.
What did we do?
We searched for studies comparing HFOV to conventional ventilation in near-term and term newborn babies with severe lung problems. We analyzed and summarized our findings and assessed our confidence in the evidence based on factors such as study methods and sizes.
What did we find?
We found three studies involving a total of 368 infants. Two studies were performed in high-income countries, and one was from an upper-middle-income country. The studies were published between 1994 and 2016. HFOV was used either as a rescue treatment when other ventilation methods failed or as the initial treatment. Infants in both treatment groups could be switched from one type of ventilator to the other if treatment failed. Our first two outcomes were whether treatment failed on the initially assigned ventilator and death.
Main results
Based on the available evidence, we are unable to draw any conclusions regarding the use of HFOV over conventional ventilation in near-term or term infants with severe lung problems. We are very uncertain about its effects on failed therapy, and it may increase the risk of death. We are very uncertain about the effects of HFOV on the occurrence of lung puncture causing abnormal air collection in the chest (pneumothorax) or on the number of days on mechanical ventilation. The included studies did not report on the development, hearing, or vision of babies when they got older.
What are the limitations of the evidence?
We have little to very low confidence in the evidence. The main reason for this was that people in the studies knew which treatments the babies had received, which could have influenced the results. In addition, the studies were very small, and there were not enough studies to be certain about the results. Finally, the studies were done in different types of babies.
How up-to-date is this evidence?
The evidence is current to 13 May 2024. This review is an update of a review last published in 2009.
Read the full abstract
Pulmonary disease is a major cause of mortality and morbidity in term and near term infants. Conventional ventilation (CV) has been used for many years but may lead to lung injury, require the subsequent use of more invasive treatment such as extracorporeal membrane oxygenation (ECMO), or result in death. There are some observational studies indicating that high frequency oscillatory ventilation (HFOV) may be more effective in these infants as compared to CV.
Objectives
To determine the effect of HFOV compared with CV on mortality and morbidity in infants born at 35 weeks' gestation or more with severe respiratory failure due to lung disease requiring mechanical ventilation.
Search strategy
We searched CENTRAL, MEDLINE, Embase, trial registries, and conference abstracts in May 2024. We also checked the references of included studies and related literature for eligible studies.
Selection criteria
Randomized or quasi-randomized trials comparing HFOV and CV in term or near term infants with intractable respiratory failure were included in this review.
Data collection and analysis
The standard methods of the Cochrane Neonatal Review Group were used. The investigators separately extracted, assessed and coded all data for each study. Any disagreement was resolved by discussion. Data were synthesized using risk ratio [RR with (95% confidence intervals, CI)] and mean difference (with standard deviation, SD).
Main results
Two trials met the inclusion criteria. One trial involving the "elective" use of HFOV randomized 118 infants at the start of CV. The other trial of "rescue" HFOV randomized 81 infants with later respiratory failure on CV. Neither trial showed evidence of a reduction in mortality at 28 days or in failed therapy on the assigned mode of ventilation requiring cross-over to the other mode. Neither study reported significant differences in the risk of pulmonary air leak, chronic lung disease (28 days or more in oxygen) or intracranial injury. In the study of elective HFOV, there was no difference noted in days on a ventilator or days in hospital. In the one rescue study, there was no difference in the risk of needing extracorporeal membrane oxygenation.
Authors' conclusions
Based on the available evidence, we are very uncertain about the effects of HFOV on failed therapy. HFOV may increase mortality. We are unable to support or refute the use of HFOV in near-term or term infants with severe pulmonary dysfunction. Further randomized controlled trials are needed, stratified by disease and including long-term neurodevelopmental outcomes. There is also a need for studies comparing newer forms of CV and HFOV.
Funding
This Cochrane review had no dedicated funding.
Registration
Protocol (1997): unavailable
Original review, first version (2001): https://doi.org/10.1002/14651858.CD002974
First update version (2009): https://doi.org/10.1002/14651858.CD002974.pub2
