Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
Department of Pediatrics, School of Medicine São Leopoldo Mandic, Campinas, São Paulo, Brazil.
Pediatr Pulmonol. 2021 Jul;56(7):1872-1888. doi: 10.1002/ppul.25428. Epub 2021 Apr 26.
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.
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.
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).
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.
高频振荡通气（HFOV）是一种替代机械通气模式，旨在减少呼吸机相关性肺损伤并改善临床结局。本研究旨在确定 HFOV 与常规机械通气（CMV）在治疗低氧性呼吸衰竭患儿中的效果差异。
检索截至 2020 年 12 月前发表的所有研究。纳入研究的人群为 28 天至 18 岁的儿童，研究类型为随机对照试验（RCT）或观察性研究，比较 HFOV 与 CMV 的使用效果。采用随机效应模型和Inverse-variance 权重进行汇总数据的荟萃分析。
共纳入 11 项研究（2605 例患儿），大多数研究评估了急性呼吸窘迫综合征患儿。参与者的平均年龄为 8.2 个月，纳入 RCT 患儿的氧合指数平均为 24.4。HFOV 对死亡率的影响无统计学意义，且不能排除临床显著危害或获益（风险比[RR]，0.93；95%置信区间[CI]，0.72 至 1.20）。两组间机械通气时间（-2.23；95%CI，-5.07 至 0.61）、治疗失败（RR，0.28；95%CI，0.08 至 1.02）和气压伤发生率（RR，0.88；95%CI，0.39 至 1.99）无显著差异。
目前证据有限，无法得出 HFOV 优于 CMV 的结论，需要进一步研究以明确其在治疗儿童急性低氧性呼吸衰竭中的作用。
