# Volume-targeted on high-frequency oscillatory ventilation in preterm infants: a systematic review

## TL;DR

This review compares volume-targeted high-frequency oscillatory ventilation with conventional ventilation in preterm infants, finding potential benefits in reducing breathing variability and carbon dioxide issues.

## Contribution

The study systematically evaluates the effects of volume-targeted HFOV in neonates, highlighting its potential clinical benefits and limitations.

## Key findings

- Volume-targeted HFOV may reduce VThf variability and hypocarbia/hypercarbia incidence.
- Findings on hypoxemia and ventilation duration are mixed.
- BPD rates and mortality outcomes show no significant differences.

## Abstract

This systematic review aimed to analyze, in neonates, the effects of high-frequency oscillatory ventilation (HFOV) with volume-targeted (VT) compared with conventional HFOV.

The authors searched PubMed, EMBASE, Cochrane, and ClinicalTrials.gov from inception until August 4th, 2024, to identify studies comparing HFOV with and without VT in neonates under 44 weeks corrected age. Outcomes analyzed were VThf, amplitude and carbon dioxide partial pressure (PCO2) variability, episodes of hypoxemia, hypocarbia or hypercarbia, duration of mechanical ventilation, rates of bronchopulmonary dysplasia (BPD) or intraventricular hemorrhage (IVH), and mortality. ROB-2 and ROBINS were used for risk of bias assessment.

This systematic review included 260 preterm infants from two crossover and four cohort studies. Five studies were considered as having a relevant risk of bias. Meta-analysis could not be performed, due to the differences in study design and incomplete reporting. The report of included studies indicates that HFOV with VT, compared with HFOV, may reduce VThf variability, hypocarbia and hypercarbia incidence. Findings on hypoxemia incidence and mechanical ventilation duration are mixed. Two studies found no difference in BPD rates, while one noted higher survival without BPD grades 2–3 under HFOV with VT. IVH, leukomalacia, and mortality outcomes were similar.

Inclusion of VT during HFOV may reduce VThf variability, hypocarbia and hypercarbia incidence. However, there is a need for randomized trials to compare clinical outcomes from both ventilatory strategies.