RATIONALE: High-frequency oscillatory ventilation (HFOV) is theoretically beneficial for lung protection, but the results of clinical trials are inconsistent, with study-level meta-analyses suggesting no significant effect on mortality. OBJECTIVES: The aim of this individual patient data meta-analysis was to identify acute respiratory distress syndrome (ARDS) patient subgroups with differential outcomes from HFOV. METHODS: After a comprehensive search for trials, two reviewers independently identified randomized trials comparing HFOV with conventional ventilation for adults with ARDS. Prespecified effect modifiers were tested using multivariable hierarchical logistic regression models, adjusting for important prognostic factors and clustering effects. MEASUREMENTS AND MAIN RESULTS: Data from 1,552 patients in four trials were analyzed, applying uniform definitions for study variables and outcomes. Patients had a mean baseline PaO2/FiO2 of 114 ± 39 mm Hg; 40% had severe ARDS (PaO2/FiO2 <100 mm Hg). Mortality at 30 days was 321 of 785 (40.9%) for HFOV patients versus 288 of 767 (37.6%) for control subjects (adjusted odds ratio, 1.17; 95% confidence interval, 0.94-1.46; P = 0.16). This treatment effect varied, however, depending on baseline severity of hypoxemia (P = 0.0003), with harm increasing with PaO2/FiO2 among patients with mild-moderate ARDS, and the possibility of decreased mortality in patients with very severe ARDS. Compliance and body mass index did not modify the treatment effect. HFOV increased barotrauma risk compared with conventional ventilation (adjusted odds ratio, 1.75; 95% confidence interval, 1.04-2.96; P = 0.04). CONCLUSIONS: HFOV increases mortality for most patients with ARDS but may improve survival among patients with severe hypoxemia on conventional mechanical ventilation.

12th Man Technologies Garden Grove California; and

Athens Medical School Evaggelismos General Hospital Athens Greece

Czech Technical University Prague Kladno Czech Republic

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada

Department of Critical Care Medicine Sunnybrook Health Science Centre Toronto Canada

Department of Medicine and

Division of Respirology Department of Medicine University Health Network and Mount Sinai Hospital Toronto General Research Institute Toronto Canada

Harvard University Boston Massachusetts

Institute for Health Policy Management and Evaluation University of Toronto Toronto Canada

Interdepartmental Division of Critical Care Medicine

Johns Hopkins University School of Medicine Baltimore Maryland

Keenan Centre for Biomedical Research Li Ka Shing Knowledge Institute St Michael's Hospital Toronto Canada

Trillium Health Partners University of Toronto Mississauga Ontario Canada

University Hospitals Bristol National Health Service Foundation Trust Bristol United Kingdom

University of Oxford Oxford United Kingdom

Wilhelmina Children's Hospital Utrecht the Netherlands

Am J Respir Crit Care Med. 2017 Sep 15;196(6):670-671. doi: 10.1164/rccm.201703-0475ED. PubMed

Am J Respir Crit Care Med. 2018 Mar 15;197(6):839. doi: 10.1164/rccm.201710-2021LE. PubMed

Am J Respir Crit Care Med. 2018 Mar 15;197(6):838-839. doi: 10.1164/rccm.201709-1927LE. PubMed

J Thorac Dis. 2018 Nov;10(Suppl 33):S4144-S4146. doi: 10.21037/jtd.2018.10.71. PubMed

References provided by Crossref.org

The harm of high-frequency oscillatory ventilation (HFOV) in ARDS is not related to a high baseline risk of acute cor pulmonale or short-term changes in hemodynamics