Is high-frequency oscillatory ventilation more effective and safer than conventional protective ventilation in adult acute respiratory distress syndrome patients? A meta-analysis of randomized controlled trials

Abstract

IntroductionComprehensively evaluating the efficacy and safety of high-frequency oscillatory ventilation (HFOV) is important to allow clinicians who are using or considering this intervention to make appropriate decisions.MethodsTo find randomized controlled trials (RCTs) comparing HFOV with conventional mechanical ventilation (CMV) as an initial treatment for adult ARDS patients, we searched electronic databases (including PubMed, MedLine, Springer Link, Elsevier Science Direct, ISI web of knowledge, and EMBASE) with the following terms: “acute respiratory distress syndrome”, “acute lung injury”, and “high frequency oscillation ventilation”. Additional sources included reference lists from the identified primary studies and relevant meta-analyses. Two investigators independently screened articles and extracted data. Meta-analysis was conducted using random-effects models.ResultsWe included 6 RCTs with a total of 1,608 patients in this meta-analysis. Compared with CMV, HFOV did not significantly reduce the mortality at 30 or 28 days. The pooled relative risk (RR) was 1.051 (95% confidence interval (CI) 0.813 to 1.358). ICU mortality was also not significantly reduced in HFOV group, with a pooled RR of 1.218 (95% CI 0.925 to 1.604). The pooled effect sizes of HFOV for oxygenation failure, ventilation failure and duration of mechanical ventilation were 0.557 (95% CI 0.351 to 0.884), 0.892 (95% CI 0.435 to 1.829) and 0.079 (95% CI −0.045 to 0.203), respectively. The risk of barotrauma and hypotension were similar between the CMV group and HFOV group, with a RR of 1.205 (95% CI 0.834 to 1.742) and a RR of 1.326 (95% CI 0.271 to 6.476), respectively.ConclusionsAlthough HFOV seems not to increase the risk of barotrauma or hypotension, and reduces the risk of oxygenation failure, it does not improve survival in adult acute respiratory distress syndrome patients.

Airway Pressure Release Ventilation and High-Frequency Oscillatory Ventilation: Potential Strategies to Treat Severe Hypoxemia and Prevent Ventilator-Induced Lung Injury

“…An updated meta-analysis of 6 RCTs (1,608 subjects), including OSCAR and OSCILLATE, confirmed that HFOV does not significantly reduce mortality, despite leading to an improvement in oxygenation. 64 As such, HFOV cannot currently be recommended for routine use in adult patients with early moderate-to-severe ARDS.…”

“…Physiological predictors of survival should be considered 66 : early changes in arterial oxygenation may identify patients with a greater proportion of recruitable lung, who are more likely to benefit from HFOV, whereas patients who require significant increases in vasopressors or with no improvement in oxygenation should be switched back to conventional mechanical ventilation. Although selected patients with severe ARDS may benefit from HFOV, Gu et al 64 pointed out in a recent meta-analysis that these patients are rare and difficult to identify. Future studies will have to consider a new approach to the use of this ventilatory strategy in subjects with ARDS.…”

Prospect in Pediatric Diseases Medicine

“…Recent studies have shown that ventilation regimes working on principle of intermittent positive pressure ventilation (IPPV), which use small tidal volumes (4-6 ml/ kg body weight) and appropriate values of positive end-expiratory pressure (PEEP, 0.4-0.7 kPa), may protect the lung of patients of all age groups, including neonates, from an additional injury (Dargaville 2012;Brown and DiBlasi 2011). However, other studies have not confirmed any clear differences between CMV and HFO (Maitra et al 2015;Gu et al 2014). HFO supplies effective gas exchange at frequencies of 5-15 Hz, or higher, with tidal volumes smaller than the dead space volume and high values of PEEP keeping the chest in prone position (Chowdhury and Greenough 2011).…”

Too Little Oxygen: Ventilation, Prone Positioning, and Extracorporeal Membrane Oxygenation for Severe Hypoxemia

“…Subsequent meta-analysis of 1,608 patients, including the OSCILLATE and OSCAR cohorts, confirmed no increase in barotrauma or hypotension with HFOV, but found no significant reduction in 28-or 30-day mortality. 28 In addition, a follow-up study evaluating 1 year quality-adjusted years of life after participation in the OSCAR trial suggested no economic advantage to HFOV in terms of incremental costs and recommended that further research on improving severe ARDS ventilation should concentrate outside of HFOV. 29 At this point, HFOV use for severe ARDS in adults cannot be recommended routinely outside of salvage situations.…”