Efficacy and adverse events of high-frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome: A meta-analysis
Journal
Critical Care
Journal Volume
18
Journal Issue
3
Pages
R102
Date Issued
2014
Author(s)
Abstract
Introduction: Theoretically, high-frequency oscillatory ventilation (HFOV) achieves all goals of a lung-protective ventilatory mode and seems ideal for the treatment of adult patients with acute respiratory distress syndrome (ARDS). However, its effects on mortality and adverse clinical outcomes remain uncertain given the paucity of high-quality studies in this area. This meta-analysis was performed to evaluate the efficacy and adverse events of HFOV in adults with ARDS.Methods: We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials through February 2014 to retrieve randomized controlled trials of HFOV in adult ARDS patients. Two independent reviewers extracted data on study methods, clinical and physiological outcomes and adverse events. The primary outcome was 30-day or hospital mortality. Risk of bias was evaluated with the Cochrane Collaboration's tool. Mortality, oxygenation and adverse effects of HFOV were compared to those of conventional mechanical ventilation. A random-effects model was applied for meta-analysis.Results: A total of five trials randomly assigning 1,580 patients met inclusion criteria. Pooled data showed that HFOV significantly improved oxygenation on day one of therapy (four studies; 24% higher; 95% confidence interval (CI) 11 to 40%; P <0.01). However, HFOV did not reduce mortality risk (five studies; risk ratio (RR) 1.04; 95% CI 0.83 to 1.31; P = 0.71) and two early terminated studies suggested a harmful effect of HFOV in ARDS (two studies; RR 1.33; 95% CI 1.09 to 1.62; P <0.01). Safety profiles showed that HFOV was associated with a trend toward increased risk of barotrauma (five studies; RR 1.19; 95% CI 0.83 to 1.72; P = 0.34) and unfavorable hemodynamics (five studies; RR 1.16; 95% CI 0.97 to 1.39; P = 0.12).Conclusions: HFOV improved oxygenation in adult patients with ARDS; however, it did not confer a survival benefit and might cause harm in the era of lung-protective ventilation strategy. The evidence suggests that HFOV should not be a routine practice in ARDS and further studies specifically selecting patients for this ventilator mode should be pursued. ? 2014 Huang et al.; licensee BioMed Central Ltd.
SDGs
Other Subjects
adult respiratory distress syndrome; adverse outcome; airway pressure; APACHE; article; artificial ventilation; clinical effectiveness; Cochrane Library; Embase; high frequency oscillation; high frequency oscillatory ventilation; high frequency ventilation; high frequency ventilator; human; lung barotrauma; lung hemodynamics; lung protection; mechanical ventilator; Medline; meta analysis; mortality; outcome assessment; oxygenation; priority journal; protection; randomized controlled trial (topic); survival; systematic review; adult; high frequency ventilation; oxygen consumption; procedures; Respiratory Distress Syndrome, Adult; treatment outcome; trends; Adult; High-Frequency Ventilation; Hospital Mortality; Humans; Oxygen Consumption; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome, Adult; Treatment Outcome
Publisher
BioMed Central Ltd.
Type
journal article