High‐frequency oscillatory ventilation in children: A systematic review and meta‐analysis

Background High‐frequency oscillatory ventilation (HFOV) is an alternative mechanical ventilation mode proposed to reduce ventilator‐induced lung injuries and improve clinical outcomes. The aim of this study was to determine the effects of HFOV compared to conventional mechanical ventilation (CMV) w...

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Bibliographic Details
Published in:	Pediatric pulmonology Vol. 56; no. 7; pp. 1872 - 1888
Main Authors:	Junqueira, Fernanda M. D., Nadal, José A. H., Brandão, Marcelo B., Nogueira, Roberto J. N., Souza, Tiago H.
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-07-2021
Subjects:	high‐frequency oscillation ventilation mechanical ventilation Meta-analysis pediatric acute respiratory distress syndrome Respiratory failure respiratory insufficiency Ventilation ventilator induced lung injury ventilator induced lung injury mechanical ventilation respiratory insufficiency high-frequency oscillation ventilation pediatric acute respiratory distress syndrome
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Summary:	Background High‐frequency oscillatory ventilation (HFOV) is an alternative mechanical ventilation mode proposed to reduce ventilator‐induced lung injuries and improve clinical outcomes. The aim of this study was to determine the effects of HFOV compared to conventional mechanical ventilation (CMV) when used in children with hypoxemic respiratory failure. Methods The literature search was conducted to identify all studies published before December 2020. Eligible studies included a population aged between 28 days and 18 years old, presented original data from randomized controlled trials (RCTs) or observational studies, compared the use of HFOV with CMV. Meta‐analyses of the pooled data were performed by using random‐effects models with inverse‐variance weighting. Results A total of 11 studies (2605 cases) were included, most of them evaluating patients with acute respiratory distress syndrome. The mean age of participants was 8.2 months and the mean oxygenation index of those included in the RCTs was 24.4. The effect of HFOV on mortality was not significant, and clinically significant harm or benefit could not be excluded (risk ratio [RR], 0.93; 95% confidence interval [CI], 0.72 to 1.20). No significant difference between groups was found in duration of mechanical ventilation (−2.23; 95% CI, −5.07 to 0.61), treatment failure (RR, 0.28; 95% CI, 0.08 to 1.02), and occurrence of barotrauma (RR, 0.88; 95% CI, 0.39 to 1.99). Conclusion The scarce evidence currently available does not allow us to conclude that HFOV has advantages over CMV and further studies are needed to clarify its role in the treatment of acute hypoxemic respiratory failure in children.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3
ISSN:	8755-6863 1099-0496
DOI:	10.1002/ppul.25428