Noninvasive High-frequency Oscillatory Ventilation As Respiratory Support in Preterm Infants: a Meta-analysis of Randomized Controlled Trials

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2019 Mar 17

PMID 30876411

Citations 16

Authors

Jing Li

Xiaoxia Li

Xianmei Huang

Zhiqun Zhang

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Methods: We 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.

Results: A 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.

Conclusions: Our 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.

Citing Articles

Non-invasive high-frequency oscillatory ventilation versus non-invasive intermittent mandatory ventilation as a rescue mode in preterm infants with respiratory distress on nasal CPAP-a randomized control trial.

Rachana R, Oleti T, Saikiran D, Vardhelli V, Thiruveedi S, Hussain A Eur J Pediatr. 2025; 184(3):205.

PMID: 39985666 DOI: 10.1007/s00431-025-06041-8.

Noninvasive high-frequency oscillation ventilation as post- extubation respiratory support in neonates: Systematic review and meta-analysis.

Prasad R, Saha B, Sk M, Sahoo J, Gupta B, Chandra Shaw S PLoS One. 2024; 19(7):e0307903.

PMID: 39078848 PMC: 11288463. DOI: 10.1371/journal.pone.0307903.

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units-The Results of a Recent Survey.

Ognean M, Bivoleanu A, Cucerea M, Galis R, Rosca I, Surdu M Children (Basel). 2024; 11(7).

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Non-invasive high-frequency ventilation in newborn infants with respiratory distress.

Abdel-Latif M, Tan O, Fiander M, Osborn D Cochrane Database Syst Rev. 2024; 5:CD012712.

PMID: 38695628 PMC: 11064768. DOI: 10.1002/14651858.CD012712.pub2.

Neonatal respiratory support strategies-short and long-term respiratory outcomes.

Kaltsogianni O, Dassios T, Greenough A Front Pediatr. 2023; 11:1212074.

PMID: 37565243 PMC: 10410156. DOI: 10.3389/fped.2023.1212074.

References

Kumar A, Bhat B . Epidemiology of respiratory distress of newborns. Indian J Pediatr. 1996; 63(1):93-8. DOI: 10.1007/BF02823875. View

Barrington K, Bull D, Finer N . Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics. 2001; 107(4):638-41. DOI: 10.1542/peds.107.4.638. View

Pillow J, Wilkinson M, Neil H, Ramsden C . In vitro performance characteristics of high-frequency oscillatory ventilators. Am J Respir Crit Care Med. 2001; 164(6):1019-24. DOI: 10.1164/ajrccm.164.6.2005008. View

De Paoli A, Morley C, Davis P, Lau R, Hingeley E . In vitro comparison of nasal continuous positive airway pressure devices for neonates. Arch Dis Child Fetal Neonatal Ed. 2002; 87(1):F42-5. PMC: 1721427. DOI: 10.1136/fn.87.1.f42. View

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Stefanescu B, Murphy W, Hansell B, Fuloria M, Morgan T, Aschner J . A randomized, controlled trial comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants. Pediatrics. 2003; 112(5):1031-8. DOI: 10.1542/peds.112.5.1031. View

Pillow J . High-frequency oscillatory ventilation: mechanisms of gas exchange and lung mechanics. Crit Care Med. 2005; 33(3 Suppl):S135-41. DOI: 10.1097/01.ccm.0000155789.52984.b7. View

Colaizy T, Younis U, Bell E, Klein J . Nasal high-frequency ventilation for premature infants. Acta Paediatr. 2008; 97(11):1518-22. PMC: 3976963. DOI: 10.1111/j.1651-2227.2008.00900.x. View

Thorpe K, Zwarenstein M, Oxman A, Treweek S, Furberg C, Altman D . A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 2009; 62(5):464-75. DOI: 10.1016/j.jclinepi.2008.12.011. View

10.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009; 339:b2535. PMC: 2714657. DOI: 10.1136/bmj.b2535. View

11.

De Luca D, Carnielli V, Conti G, Piastra M . Noninvasive high frequency oscillatory ventilation through nasal prongs: bench evaluation of efficacy and mechanics. Intensive Care Med. 2010; 36(12):2094-100. DOI: 10.1007/s00134-010-2054-7. View

12.

Shah P, Sankaran K, Aziz K, Allen A, Seshia M, Ohlsson A . Outcomes of preterm infants <29 weeks gestation over 10-year period in Canada: a cause for concern?. J Perinatol. 2011; 32(2):132-8. DOI: 10.1038/jp.2011.68. View

13.

Higgins J, Altman D, Gotzsche P, Juni P, Moher D, Oxman A . The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. PMC: 3196245. DOI: 10.1136/bmj.d5928. View

14.

Natarajan G, Pappas A, Shankaran S, Kendrick D, Das A, Higgins R . Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition. Early Hum Dev. 2012; 88(7):509-15. PMC: 3686277. DOI: 10.1016/j.earlhumdev.2011.12.013. View

15.

De Luca D, Piastra M, Pietrini D, Conti G . Effect of amplitude and inspiratory time in a bench model of non-invasive HFOV through nasal prongs. Pediatr Pulmonol. 2012; 47(10):1012-8. DOI: 10.1002/ppul.22511. View

16.

Mukerji A, Finelli M, Belik J . Nasal high-frequency oscillation for lung carbon dioxide clearance in the newborn. Neonatology. 2012; 103(3):161-5. DOI: 10.1159/000345613. View

17.

Mukerji A, Singh B, El Helou S, Fusch C, Dunn M, Belik J . Use of noninvasive high-frequency ventilation in the neonatal intensive care unit: a retrospective review. Am J Perinatol. 2014; 30(2):171-6. DOI: 10.1055/s-0034-1381317. View

18.

Fischer H, Bohlin K, Buhrer C, Schmalisch G, Cremer M, Reiss I . Nasal high-frequency oscillation ventilation in neonates: a survey in five European countries. Eur J Pediatr. 2014; 174(4):465-71. DOI: 10.1007/s00431-014-2419-y. View

19.

Hadj-Ahmed M, Samson N, Nadeau C, Boudaa N, Praud J . Laryngeal muscle activity during nasal high-frequency oscillatory ventilation in nonsedated newborn lambs. Neonatology. 2015; 107(3):199-205. DOI: 10.1159/000369120. View

20.

Thome U, Genzel-Boroviczeny O, Bohnhorst B, Schmid M, Fuchs H, Rohde O . Permissive hypercapnia in extremely low birthweight infants (PHELBI): a randomised controlled multicentre trial. Lancet Respir Med. 2015; 3(7):534-43. DOI: 10.1016/S2213-2600(15)00204-0. View