Early Initiation of High-Frequency Jet Ventilation (Hfjv) in the Management of Respiratory Distress Syndrome (Rds) Is Associated Witha Greater Risk for Adverse Outcomes: A Prospective, Randomized, Controlled Trial

Wiswell, Thomas E.; Graziani, Leonard J.; Kornhauser, Michael; Cullen, James A.; Spitzer, Alan R.

doi:10.1203/00006450-199604001-02142

Cited by 36 publications

(56 citation statements)

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“…11 A recent publication of another high-frequency mode, namely jet ventilation, found an increased incidence of cystic PVL with the ventilatory strategy used in that study. 28 Another recent meta-analysis of IVH and high-frequency ventilation in which two different modes of high-frequency ventilation (HFOV and high-frequency jet ventilation) were combined showed a nonsignificant trend towards increase in IVH but a significant increase in PVL if the HIFI study 9 was included. 29 Whether it was one of the mentioned mechanisms or just lack of experience with a new technology at…”

Section: Neurodevelopmental Outcomesmentioning

confidence: 99%

Elective High-frequency Oscillatory Ventilation Versus Conventional Ventilation in Preterm Infants With Pulmonary Dysfunction: Systematic Review and Meta-analyses

Bhuta

Henderson‐Smart

1997

Pediatrics

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ABSTRACT. Objectives. To systematically review the evidence to determine whether the routine use of highfrequency 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.Methods. 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.Results. Four published trials 9,18 -20 were included. Meta-analyses revealed the following ERR (95% confidence intervals) for HFOV versus CV 19Conclusions. The overall meta-analysis is dominated by the HIFI study, 9 which was criticized for its methodology 11 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 20 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. Pediatrics 1997;100(5). URL: http://www.pediatrics.org/ cgi/content/full/100/5/e6; meta-analyses, high-frequency ventilation, high-frequency oscillatory ventilation, chronic lung disease, preterm, neonatal ventilation, neonatal morbidity.

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Section: Neurodevelopmental Outcomesmentioning

confidence: 99%

Elective High-frequency Oscillatory Ventilation Versus Conventional Ventilation in Preterm Infants With Pulmonary Dysfunction: Systematic Review and Meta-analyses

Bhuta

Henderson‐Smart

1997

Pediatrics

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“…The meta-analysis that included this trial and one other trial that reported on this outcome demonstrated a trend towards decreased CLD at 36 weeks in survivors (typical RR 0.59, 95% CI 0.35, 0.99). Of concern, one of the trials of elective HFOV 24 had a trend towards increased severe IVH; however, when analyzed with the one other trial that reported on severe IVH, no significant increase was noted (typical RR 1.37, 95% CI 0.79, 2.37). In addition, Wiswell et al 24 reported a significant increase in the risk of periventricular leukomalacia.…”

Section: Elective Hfjv Vs Conventional Ventilation For Rds In Pretermmentioning

confidence: 98%

“…Of concern, one of the trials of elective HFOV 24 had a trend towards increased severe IVH; however, when analyzed with the one other trial that reported on severe IVH, no significant increase was noted (typical RR 1.37, 95% CI 0.79, 2.37). In addition, Wiswell et al 24 reported a significant increase in the risk of periventricular leukomalacia. When combined with the trial of Keszler et al, 25 no significant increase in risk was noted (typical RR 1.24, 95% CI 0.59, 2.61) ( Table 3).…”

Section: Elective Hfjv Vs Conventional Ventilation For Rds In Pretermmentioning

confidence: 98%

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The clinical impact of high frequency ventilation: review of the cochrane meta-analyses

Soll

2006

J Perinatol

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Experimental work in animal models suggests that ventilation strategies using high frequency oscillatory ventilation or high frequency jet ventilation hold great promise in the prevention of lung injury in preterm infants. However, clinical trials of either modality demonstrate little clinical benefit and there are possibilities of adverse effects, including increased risk of intraventricular hemorrhage and poor neurological development.

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“…3 Three trials 9-11 were conducted after surfactants became available for treatment of RDS (Table 1). Two of these studies 9,10 reported lower BPD incidence among infants randomized to high-frequency ventilation (HFV) when compared to IMV, while Wiswell et al 11 had to stop their study because of increase in IVH or PVL among infants randomized to HFJV. Among the eight HFV trials [12][13][14][15][16][17][18][19] published between 1998 and 2003, when surfactant therapy and SIMV were commonly used, only two studies reported a decrease in BPD 13 with HFOV use, and two studies 14,18 reported an increase in air leaks with HIFI use.…”

Section: Introductionmentioning

confidence: 99%

Lung protective ventilatory strategies in very low birth weight infants

Ramanathan

Sardesai

2008

J Perinatol

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Respiratory distress syndrome (RDS) is the most common respiratory diagnosis in preterm infants. Surfactant therapy and mechanical ventilation using conventional or high-frequency ventilation have been the standard of care in the management of RDS. Bronchopulmonary dysplasia (BPD) continues to remain as a major morbidity in very low birth weight infants despite these treatments. There is no significant difference in pulmonary outcome when an optimal lung volume strategy is used with conventional or high-frequency ventilation. Lung injury is directly related to the duration of invasive ventilation via the endotracheal tube. Studies using noninvasive ventilation, such as nasal continuous positive airway pressure and noninvasive positive pressure ventilation, have shown to decrease postextubation failures as well as a trend toward reduced risk of BPD. Lung protective ventilatory strategy may involve noninvasive ventilation as a primary therapy or following surfactant administration in very preterm infants with RDS. Initial steps in the management of preterm infants may also include sustained inflation to establish functional residual capacity, followed by noninvasive ventilation to minimize lung injury and subsequent development of BPD.

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Early Initiation of High-Frequency Jet Ventilation (Hfjv) in the Management of Respiratory Distress Syndrome (Rds) Is Associated Witha Greater Risk for Adverse Outcomes: A Prospective, Randomized, Controlled Trial

Cited by 36 publications

References 0 publications

Elective High-frequency Oscillatory Ventilation Versus Conventional Ventilation in Preterm Infants With Pulmonary Dysfunction: Systematic Review and Meta-analyses

Elective High-frequency Oscillatory Ventilation Versus Conventional Ventilation in Preterm Infants With Pulmonary Dysfunction: Systematic Review and Meta-analyses

The clinical impact of high frequency ventilation: review of the cochrane meta-analyses

Lung protective ventilatory strategies in very low birth weight infants

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