High-frequency oscillatory ventilation with volume guarantee in infants: a systematic review.

Summary

Across 11 studies (including three RCTs; n=785), HFOV with volume guarantee increased survival free of grade 2–3 BPD versus HFOV alone (OR 3.15, 95% CI 1.66–5.98). Signals suggested shorter invasive ventilation and hospital stay and potential reductions in mortality and air leak, though overall BPD incidence was unchanged.

Key Findings

• HFOV-VG increased survival free of grade 2–3 BPD versus HFOV alone (OR 3.15, 95% CI 1.66–5.98).
• No reduction in overall BPD incidence was observed compared with HFOV alone.
• Signals of shorter invasive ventilation and hospital stay, with potential reductions in mortality and air leak syndrome.

Clinical Implications

When HFOV is selected for preterm infants (<32 weeks GA), combining VG may improve survival free of severe BPD and shorten support, but practice should await confirmation from large multicenter RCTs.

Limitations

• Heterogeneity across study designs and populations; limited number of RCTs.
• Potential publication bias and lack of uniform definitions of outcomes.

Future Directions

Conduct adequately powered, multicenter RCTs to confirm effects of HFOV-VG on BPD grades, mortality, and ventilator days, and to define optimal settings.