Noninvasive high-frequency oscillatory ventilation as respiratory support in preterm infants: a meta-analysis of randomized controlled trials

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.

Efficacy of noninvasive respiratory support modes as postextubation respiratory support in preterm neonates: A systematic review and network meta‐analysis

“…Ten studies were adjudged as having a high risk of bias due to issues in random sequence generation and allocation concealment. 30,32,33,39,40,[43][44][45]47,53 Eight studies had a low risk of bias 21,23,25,26,42,48,50,52 and fifteen studies had variable risk of bias. 22,24,[27][28][29]31,[34][35][36][37][38]41,46,49,51 Due to the nature of the intervention, blinding of the personnel and outcome assessor was not possible and hence all the trials scored a high risk of bias for the same.…”

“…58 There were only two RCTs evaluating the efficacy of nHFOV with most of the evidence being contributed by the indirect fraction from other comparisons. 52,53 A recent meta-analysis had shown that nHFOV was better in preventing reintubation than CPAP. 59 Most of the trials included in this meta-analysis were small, and most had used nHFOV as a primary respiratory support.…”

“…52,53 A recent meta-analysis had shown that nHFOV was better in preventing reintubation than CPAP. 59 Most of the trials included in this meta-analysis were small, and most had used nHFOV as a primary respiratory support. Further large studies are needed to evaluate the efficacy and safety of nHFOV.…”

Efficacy of noninvasive respiratory support modes for primary respiratory support in preterm neonates with respiratory distress syndrome: Systematic review and network meta‐analysis

“…3 Newer modalities of NRS strategies that have come into practice in neonatal medicine in the past two decades, include heated and humidified high flow cannula (HFNC), noninvasive positive pressure ventilation (NIPPV), bilevel CPAP (Bi-PAP) as well as nasal high-frequency oscillation ventilation (nHFOV). 4,5 Several systematic reviews compared different NRS strategies in pair-wise meta-analysis, however, only one network meta-analysis (NMA) evaluated different NRS strategies in preterm neonates with RDS. [6][7][8][9][10] The NMA by Isamaya et al 10 and mechanical ventilation [MV] following surfactant) along with CPAP and NIPPV.…”

Less invasive surfactant administration combined with nasal high frequency oscillatory ventilation for an extremely low birth weight infant with severe hypercapnia

“…However, some studies have provided evidence in support of the potential benefits. [ 9 , 10 ] A recent study confirms that LISA strategies decrease the risks of the composite outcome of BPD or death and of early nCPAP failure when compared to “intubation-surfactant-extubation” approaches, [ 9 ] and the latest European guideline recommends that LISA is the preferred mode of surfactant administration for spontaneously breathing babies on nCPAP for experienced clinicians. [ 3 ] Our meta-analysis found that in preterm infants, the use of nHFOV rather than nCPAP was beneficial in terms of improved CO 2 elimination and a reduced risk of intubation for mechanical ventilation.…”