Abstract
BackgroundNoninvasive high-frequency oscillatory ventilation (nHFOV), a relatively new modality, is gaining popularity despite scarce evidence. This meta-analysis was designed to evaluate the efficacy and safety of nHFOV as respiratory support in premature infants.MethodsWe searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL from inception of the database to January 2019. All published randomized controlled trials (RCTs) evaluating the effect of nHFOV therapy with nasal continuous positive airway pressure (nCPAP) or biphasic nCPAP (BP-CPAP) in newborns for respiratory support were included. All meta-analyses were performed using Review Manager 5.3.ResultsA total of 8 RCTs involving 463 patients were included. The meta-analysis estimated a lower risk of intubation (relative risk = 0.50, 95% confidence interval of 0.36 to 0.70) and more effective clearance of carbon dioxide (weighted mean difference = − 4.61, 95% confidence interval of − 7.94 to − 1.28) in the nHFOV group than in the nCPAP/BP-CPAP group.ConclusionsOur meta-analysis of RCTs suggests that nHFOV, as respiratory support in preterm infants, significantly remove carbon dioxide and reduce the risk of intubation compared with nCPAP/BP-CPAP. The appropriate parameter settings for different types of noninvasive high-frequency ventilators, the effect of nHFOV in extremely preterm infants, and the long-term safety of nHFOV need to be assessed in large trials.
Highlights
Noninvasive high-frequency oscillatory ventilation, a relatively new modality, is gaining popularity despite scarce evidence
Applied noninvasive high-frequency oscillatory ventilation may combine the benefits of nasal continuous positive airway pressure (nCPAP) and high-frequency ventilation, which include the absence of ventilator-patient asynchrony and high efficacy in removing carbon dioxide (CO2) [10]. Noninvasive high-frequency oscillatory ventilation (nHFOV) is already used in European neonatal intensive care units despite scarce evidence to support the routine use of nHFOV [11]
Meta-analysis indicated that nHFOV significantly reduced Partial pressure of carbon dioxide (pCO2) in preterm infants compared with nCPAP/biphasic nCPAP (BP-CPAP), including pCO2 levels (WMD = − 4.61, 95% CI -7.94 to − 1.28, I2 = 67%, P = 0.007) after respiratory support and ΔpCO2 (WMD = − 4.89, 95% CI -8.36 to − 1.42, I2 = 70%, P = 0.006) before and after respiratory support (Fig. 2)
Summary
Noninvasive high-frequency oscillatory ventilation (nHFOV), a relatively new modality, is gaining popularity despite scarce evidence. This meta-analysis was designed to evaluate the efficacy and safety of nHFOV as respiratory support in premature infants. The goals of managing respiratory distress include maintaining airway patency and providing respiratory support to deliver oxygen and remove carbon dioxide. Applied noninvasive high-frequency oscillatory ventilation (nHFOV) may combine the benefits of nCPAP and high-frequency ventilation, which include the absence of ventilator-patient asynchrony and high efficacy in removing carbon dioxide (CO2) [10]. Reviews of observational studies show an advantage with nHFOV for CO2 clearance in preterm infants treated for respiratory distress syndrome [12,13,14]. Because of the conflicting findings from reviews of observational studies and randomized trials, we have conducted a comprehensive systematic review evaluating all evidence by collecting data from randomized trials and prospective cohort studies
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