Bhuta T, Henderson-Smart D J
NSW Centre for Perinatal Health Services Research, Queen Elizabeth II Institute for Mothers and Infants, Building DO2, University of Sydney, Sydney, NSW, Australia, 2006.
Cochrane Database Syst Rev. 2000;1998(2):CD000438. doi: 10.1002/14651858.CD000438.
This section is under preparation and will be included in the next issue.
Experimental studies suggest that high frequency oscillatory ventilation (HFOV) reduces pulmonary injury during mechanical ventilation. The main objective of this review is to test the hypothesis that by use of HFOV as compared to conventional ventilation (CV) it may be possible to rescue preterm infants with very severe lung disease and so at high risk of pulmonary air leak (PAL), without adverse effects.
A search was carried out for all randomized controlled trials from MEDLINE using the MeSH and text terms, "high frequency ventilation", "high frequency oscillatory ventilation", " oscillatory ventilation" from the years 1980 to 1997. EMBASE, the Oxford Database of Perinatal Trials and trials identified by the Neonatal Review Group of the Cochrane Collaboration were also reviewed. Information was also sought from experts in the field, cross references from studies and proceedings of recent meetings.
Randomized controlled trials of HFOV vs CV as rescue therapy in preterm infants with severe pulmonary dysfunction.
The standard review method of the Neonatal Review Group was used. This includes independent quality assessment and data extraction by the second author. Relative risk (RR), risk difference (RD) and number needed to treat (NNT) were used.
Only one trial was found and this showed a reduction in any new pulmonary air leak (PAL) [RR 0.73 (0.55,0.96), RD -0.174 (-0.321,-0.027)]. The number of infants that need to be treated (NNT) to prevent one infant having any PAL is six (95% CI 3, 37). There is no difference in the rate of PIE or of gross pulmonary air leak, such as pneumomediastinum or pneumothorax. Mortality and the use of IPPV at 30 days was similar in the HFOV and CV groups. The rate of intraventricular hemorrhage (IVH) of any grade is increased in infants treated with HFOV, RR 1.77 (1.06,2.96), RD 0.156 (0.020, 0. 291). Thus for every six infants (95% CI 3, 50) given rescue HFOV, one IVH of any grade is caused. There is a stronger but non-significant trend towards an increase in the more severe grades 3 or 4 IVH.
REVIEWER'S CONCLUSIONS: There is insufficient information on the use of rescue HFOV to make recommendations for practice. The small amount of data that exists suggest that harm might outweigh any benefit. Any future use of HFOV as rescue therapy for preterm infants with severe RDS should be within randomized controlled trials and address important outcomes such as longer term pulmonary and neurological function.
本节正在编写中，将在下一期发表。
实验研究表明，高频振荡通气（HFOV）可减少机械通气期间的肺损伤。本综述的主要目的是检验以下假设：与传统通气（CV）相比，使用HFOV可能挽救患有非常严重肺部疾病且因此有高肺漏气（PAL）风险的早产儿，且无不良影响。
使用医学主题词（MeSH）和文本词，对1980年至1997年MEDLINE中的所有随机对照试验进行检索，检索词为“高频通气”“高频振荡通气”“振荡通气”。还对EMBASE、牛津围产期试验数据库以及Cochrane协作网新生儿综述组确定的试验进行了综述。还向该领域的专家咨询信息，查阅研究的交叉参考文献以及近期会议的论文集。
HFOV与CV作为挽救治疗用于患有严重肺功能障碍的早产儿的随机对照试验。
采用新生儿综述组的标准综述方法。这包括由第二作者进行独立的质量评估和数据提取。使用相对危险度（RR）、危险度差值（RD）和需要治疗的人数（NNT）。
仅找到一项试验，该试验显示任何新的肺漏气（PAL）有所减少[RR 0.73（0.55，0.96），RD -0.174（-0.321，-0.027）]。为预防一名婴儿出现任何PAL而需要治疗的婴儿人数（NNT）为6名（95%可信区间3，37）。肺间质气肿（PIE）或严重肺漏气（如纵隔气肿或气胸）的发生率无差异。HFOV组和CV组在30天时的死亡率和间歇正压通气（IPPV）的使用情况相似。接受HFOV治疗的婴儿任何级别的脑室内出血（IVH）发生率增加，RR 1.77（1.06，2.96），RD 0.156（0.020，0.291）。因此，每6名接受挽救性HFOV治疗的婴儿（95%可信区间3，50）中，就有1名会发生任何级别的IVH。3级或4级更严重IVH增加的趋势更强但无统计学意义。
关于使用挽救性HFOV的信息不足，无法为临床实践提供建议。现有的少量数据表明，危害可能超过任何益处。未来将HFOV作为患有严重呼吸窘迫综合征（RDS）的早产儿的挽救治疗方法使用时，应在随机对照试验范围内进行，并关注诸如长期肺功能和神经功能等重要结局。
