High Frequency Oscillatory Ventilation For Adult Patients With Acute Respiratory Distress Syndrome: An Updated Systematic Review And Meta-analysis

Objective The clinical effects and safety of high frequency oscillatoryventilation (HFOV) have been studied in many trials, but the results areconflictive. Our updated meta-analysis was performed to investigatewhether high frequency oscillatory ventilation could reduce the30daymortality of adult patients with acute respiratory distress syndrome (ARDS)or increase ventilation associated risks, as compared with conventionalmechanical ventilation (CMV).Methods Databases: VIP database, Wangfang Database, CBM,Pubmed, Embase, etc. were searched, including all related papers publishedup to May2013.We screened literatures according inclusion and excludingcriteria, then extracted data. Use Revman5.1and STATA12.0to analyzedata.Results Five randomized controlled trials with1,677participants withARDS were included. All included trials aimed to analyze high frequencyoscillatory ventilation compared with conventional mechanical ventilation used in adult patients with acute respiratory distress syndrome. We foundthere were no significant differences in primary outcome:30day mortalitybetween HFOV and CMV (risk ratio0.92,95%confidence interval0.67～1.27, P=0.62＞0.05). HFOV could not reduce the duration of ventilationcompared with CMV (SMD=0.09,95%confidence interval-0.02～0.19,P=0.095＞0.05). The partial pressure of oxygen to inspired fraction ofoxygen at day1, day2and day3was improved higher in HFOV group thanCMV group (day1： SMD=0.4195%CI0.28～0.53,P＜0.05； day2SMD=0.5095%CI0.37～0.64,P＜0.05；dya3：SMD=0.6095%CI0.46～0.75,P＜0.05). And the use of HFOV couldn’t lead to additional risks ofventilation: airleak (RR0.71,95%CI0.37～1.36, P=0.981＞0.05)、hypotension(RR0.97,95%CI0.23～4.15, P=0.17＞0.05).Conclusions High frequency oscillatory ventilation might not improvesurvival of adult patients with ARDS，as compared with conventionalmechanical ventilation but it might be safe. But it still needs furtherresearch to study the effectiveness and security of high frequencyoscillatory ventilation in adult patients with acute respiratory distresssyndrome.