Elective high-frequency oscillatory ventilation versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patient data

Summary Background Population and study design heterogeneity has confounded previous meta-analyses, leading to uncertainty about eff ectiveness and safety of elective high-frequency oscillatory ventilation (HFOV) in preterm infants. We assessed eff ectiveness of elective HFOV versus conventional ventilation in this group. Methods We did a systematic review and meta-analysis of individual patients’ data from 3229 participants in ten randomised controlled trials, with the primary outcomes of death or bronchopulmonary dysplasia at 36 weeks’ postmenstrual age, death or severe adverse neurological event, or any of these outcomes. Findings For infants ventilated with HFOV, the relative risk of death or bronchopulmonary dysplasia at 36 weeks’ postmenstrual age was 0·95 (95% CI 0·88–1·03), of death or severe adverse neurological event 1·00 (0·88–1·13), or any of these outcomes 0·98 (0·91–1·05). No subgroup of infants (eg, gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids) benefi ted more or less from HFOV. Ventilator type or ventilation strategy did not change the overall treatment effect. Interpretation HFOV seems equally eff ective to conventional ventilation in preterm infants. Our results do not support selection of preterm infants for HFOV on the basis of gestational age, birthweight for gestation, initial lung disease severity, or exposure to antenatal corticosteroids.