Elective high-frequency oscillatory ventilation in preterm infants: a meta-analysis of individual patient data

Cools, Filip, Askie, Lisa, Asselin Offriga, J.M. Martin, Calvert, S.A., Courtney, S.E., Dani, C., Durand, D.J., Gerstmann, D.R., Henderson-Smith, D.J., Marlow, N., Peacock, J.L., Pillow, J.J., Soll, R.F., Thome, U.H., Truffert, P., Schreiber, M.D., Reempts Van, P., Ventettuoli, V. and Vento, G. (2010) Elective high-frequency oscillatory ventilation in preterm infants: a meta-analysis of individual patient data. The Lancet. (doi:10.1016/S0140-6736(10)60278-4). (In Press)

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, birth weight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids.
Funding Nestlé Belgium, Belgian Red Cross, and Dräger International

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