Dr Filip Cools MD a , Lisa M Askie PhD b, Martin Offringa MD c, Jeanette M Asselin RRT d, Sandra A Calvert MB e, Sherry E Courtney MD f, Carlo Dani MD g, David J Durand MD d, Dale R Gerstmann MD h, Prof David J Henderson-Smart FRACP i, Neil Marlow DM j, Prof Janet L Peacock PhD k, J Jane Pillow FRACP l, Prof Roger F Soll MD m, Ulrich H Thome MD n, Patrick Truffert MD o, Michael D Schreiber MD p, Patrick Van Reempts MD q, Valentina Vendettuoli MD r, Giovanni Vento MD s, on behalf of the PreVILIG collaboration. The Lancet, Early Online Publication, 1 June 2010
Background
Population and study design heterogeneity has confounded previous meta-analyses, leading to uncertainty about effectiveness and safety of elective high-frequency oscillatory ventilation (HFOV) in preterm infants. We assessed effectiveness of elective HFOV versus conventional ventilation in this group.
Methods
We did a systematic review and meta-analysis of individual patients’ data from 3229 participants in ten randomised controlled trials, with the primary outcomes of death or bronchopulmonary dysplasia at 36 weeks’ postmenstrual age, death or severe adverse neurological event, or any of these outcomes.
Findings
For infants ventilated with HFOV, the relative risk of death or bronchopulmonary dysplasia at 36 weeks’ postmenstrual age was 0·95 (95% CI 0·88—1·03), of death or severe adverse neurological event 1·00 (0·88—1·13), or any of these outcomes 0·98 (0·91—1·05). No subgroup of infants (eg, gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids) benefited more or less from HFOV. Ventilator type or ventilation strategy did not change the overall treatment effect.
Interpretation
HFOV seems equally effective to conventional ventilation in preterm infants. Our results do not support selection of preterm infants for HFOV on the basis of gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids.
Funding
Nestlé Belgium, Belgian Red Cross, and Dräger International.
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