Bhuta T, Henderson-Smart D J
NSW Center for Perinatal Health Services Research at the University of Sydney and Department of Neonatal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Pediatrics. 1997 Nov;100(5):E6. doi: 10.1542/peds.100.5.e6.
To systematically review the evidence to determine whether the routine use of high-frequency oscillatory ventilation (HFOV) as compared with conventional ventilation (CV) is beneficial or harmful in preterm infants requiring mechanical ventilation for pulmonary failure principally due to respiratory distress syndrome.
All randomized controlled trials of elective HFOV versus CV in preterm infants <36 weeks' gestation with respiratory failure mainly attributable to respiratory distress syndrome were identified from the literature through a search of MEDLINE, EMBASE, Oxford database of Perinatal trials, and previous reviews including cross-references and abstracts. Meta-analyses using event rate ratios (ERR), event rate difference, and if significant, number needed-to-treat were calculated (95% confidence limits were used for all analyses). Two prespecified subgroup analyses were performed.
Four published trials were included. Meta-analyses revealed the following ERR (95% confidence intervals) for HFOV versus CV: mortality at 28 to 30 days, 1.02 (0.76, 1.39); chronic lung disease (CLD) at 28 days, 0.86 (0.73, 1.01); mortality or CLD, 0.9 (0.80, 1. 01); air-leak syndromes, 1.13 (0.97, 1.33); mechanical ventilation at 28 days, 1.06 (0.84, 1.33); supplemental oxygen at discharge, 0. 59 (0.37, 0.92); intraventricular hemorrhage (IVH) all grades, 1.11 (0.95, 1.29); IVH (grades 3 or 4), 1.32 (1.01, 1.72); and periventricular leukomalacia, 1.39 (0.91, 2.13). In the subgroup of trials in which a high volume strategy (HVS) was used the ERR for CLD was 0.53 (0.36, 0.78); mortality or CLD, 0.56 (0.40, 0.77); supplemental oxygen at discharge, 0.57 (0.36, 0.92); IVH (all grades), 0.90 (0.61, 1.33); and IVH (grades 3 or 4), 0.84 (0.39, 1. 84). Results were similar to these for the trials using surfactant. One recent trial suggests that HFOV may reduce the cost of in-hospital care.
The overall meta-analysis is dominated by the HIFI study, which was criticized for its methodology and surfactant was not used. Subsequent studies, most of which used HVS and/or surfactant, have shown benefits in measures of CLD without an increase in rates of IVH. Caution is warranted in interpreting these results because: 1) the treatment is not blinded and this could affect some outcomes; 2) except for one small trial postneonatal survival, lung function, and neurodevelopment have not been reported from HVS trials; and 3) the benefits and disadvantages have not been reported in infants born at different gestational ages or different birth weights. Importantly, results from groups experienced in the use of HFOV may not be readily generalizable.
系统回顾相关证据，以确定对于主要因呼吸窘迫综合征而需机械通气治疗肺功能衰竭的早产儿，常规使用高频振荡通气（HFOV）相较于传统通气（CV）是有益还是有害。
通过检索MEDLINE、EMBASE、牛津围产期试验数据库以及既往综述（包括交叉引用和摘要），从文献中识别出所有关于胎龄小于36周、主要因呼吸窘迫综合征导致呼吸衰竭的早产儿中，择期使用HFOV与CV进行比较的随机对照试验。使用事件发生率比（ERR）、事件发生率差异进行荟萃分析，若有显著性差异，则计算所需治疗人数（所有分析均使用95%置信区间）。进行了两项预先设定的亚组分析。
纳入了四项已发表的试验。荟萃分析显示HFOV与CV相比的下列ERR（95%置信区间）：28至30天死亡率，1.02（0.76，1.39）；28天时慢性肺部疾病（CLD），0.86（0.73，1.01）；死亡率或CLD，0.9（0.80，1.01）；气漏综合征，1.13（0.97，1.33）；28天时机械通气，1.06（0.84，1.33）；出院时补充氧气，0.59（0.37，0.92）；所有级别的脑室内出血（IVH），1.11（0.95，1.29）；IVH（3级或4级），1.32（1.01，1.72）；以及脑室周围白质软化，1.39（0.91，2.13）。在采用高容量策略（HVS）的试验亚组中，CLD的ERR为0.53（0.36，0.78）；死亡率或CLD，0.56（0.40，0.77）；出院时补充氧气，0.57（0.36，0.92）；IVH（所有级别），0.90（0.61，1.33）；以及IVH（3级或4级），0.84（0.39，1.84）。使用表面活性剂的试验结果与此相似。一项近期试验表明HFOV可能降低住院治疗费用。
总体荟萃分析主要受HIFI研究主导，该研究因其方法受到批评且未使用表面活性剂。随后的研究大多采用HVS和/或表面活性剂，显示在CLD指标方面有获益且IVH发生率未增加。在解释这些结果时需谨慎，原因如下：1）治疗未设盲，这可能影响某些结果；2）除一项关于新生儿期后生存的小型试验外，HVS试验未报告肺功能和神经发育情况；3）不同胎龄或不同出生体重的婴儿的获益和风险尚未报告。重要的是，有HFOV使用经验的组的结果可能不易推广。
