Volume guarantee on high-frequency oscillatory ventilation in preterm
infants: a systematic review.
Abstract
OBJECTIVES: High-frequency oscillatory ventilation with volume
guarantee (HFOV with VG) can optimize respiratory support in preterm
infants. However, its superiority over conventional HFOV remains
uncertain. This systematic review aimed to analyze ventilatory and
clinical effects of HFOV with VG compared with conventional HFOV in
neonates under 44 weeks corrected gestational age. METHODS: We
systematically searched Pubmed, EMBASE, Cochrane, and ClinicalTrials.gov
from inception until August 4th, 2023, to identify randomized or
observational studies comparing HFOV with VG with HFOV without VG in in
neonates under 44 weeks corrected gestational age. Outcomes of interest
included high-frequency tidal volume (VThf) and amplitude oscillations,
carbon dioxide diffusion coefficient (DCO2) and carbon dioxide partial
pressure (PaCO2) mean values, and episodes of hypocarbia or hypercarbia,
hypoxemia episodes, duration of mechanical ventilation, rates of
bronchopulmonary dysplasia and intraventricular hemorrhage, and death.
ROB-2 and ROBINS were used for risk of bias assessment. RESULTS:
This study included 260 patients from two crossover and four cohort
studies. Gestational age at birth ranged from 23 to 29 weeks. The
included studies presented a considerable risk of bias. A meta-analysis
could not be performed, due to the differences in studies’ design,
relevant risk of bias, incomplete reporting, and differences in
ventilatory settings and reference values adopted. Report of the
findings suggest that HFOV with VG, compared with HFOV, may reduce VThf
variability and, consequently, hypo- and hypercarbia episodes. However,
no significant differences in terms of BPD, IVH or mortality were
observed. CONCLUSION: This systematic review does not provide
evidence of the superiority of HFOV with VG over conventional HFOV in
the context of ventilation of preterm infants, indicating the need for
further studies evaluating the effects of VG on HFOV.