Introduction Comprehensively evaluating the efficacy and safety of high-frequency oscillatory ventilation

Introduction Comprehensively evaluating the efficacy and safety of high-frequency oscillatory ventilation (HFOV) is important to allow clinicians who are using or considering this intervention to make appropriate decisions. confidence interval (CI) 0.813 to 1 1.358). ICU mortality was also not really low in HFOV group, having a pooled RR of just one 1.218 (95% CI 0.925 to at least one 1.604). The pooled impact sizes of HFOV for oxygenation failing, air flow failing and duration of mechanical ventilation were 0.557 (95% CI 0.351 to 0.884), 0.892 (95% CI 0.435 to 1 1.829) and 0.079 (95% CI ?0.045 to 0.203), respectively. The risk of barotrauma and hypotension were similar between the CMV group and HFOV group, with a RR of 1 1.205 (95% CI 0.834 to 1 1.742) and a RR of 1 1.326 (95% CI 0.271 to 6.476), respectively. Conclusions Although HFOV seems not to increase the risk of barotrauma or hypotension, and reduces the risk of oxygenation failure, it does not improve survival in adult acute respiratory distress syndrome patients. Introduction Both acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life-threatening conditions that are usually associated with substantial morbidity [1,2], mortality [3], and financial costs [4]. Conventional mechanical ventilation (CMV) is still considered the cornerstone of treatment for these patients. However, although mechanical ventilation can maintain existence, it could trigger further lung damage [5-8]. In order to avoid ventilator-induced lung damage, lung-protective ventilation continues to be recommended, which centered on staying away from cyclic alveolar re-expansion and collapse, preventing alveolar surplus distension, and maintaining and achieving alveolar recruitment [9-11]. High-frequency oscillation can be an substitute mechanical ventilation technique that delivers really small tidal quantities at high frequencies (3 to 15?Hz) using an oscillatory pump [12]. High-frequency oscillatory air flow (HFOV) will not only prevent over-distension of alveoli by providing small tidal quantities but may also prevent end-expiratory alveolar collapse and 136668-42-3 IC50 keep maintaining alveolar recruitment through the use of a continuing airway pressure [13-15]. Consequently, HFOV achieves all goals pursued by lung-protective air flow strategies LRP11 antibody [11 theoretically,16,17]. Nevertheless, only six randomized managed tests (RCTs) in adult ARDS patients have been published on the safety and efficacy of HFOV as an initial treatment strategy. Three previous trials comparing HFOV with CMV suggested that HFOV improved both oxygenation and survival in adults with ARDS [18-20], but two recent larger-scale RCTs presented different or even opposite results [21,22]. Therefore, this approach remains an unproven and controversial therapy for adults with ARDS [23-26]. Two Cochrane reviews examining the effect of HFOV on mortality in ALI/ARDS patients have been published. The earlier one found only two small RCTs and was not powerful enough to draw definitive conclusions [27]; the later study [28] concluded that HFOV might improve survival, that was not really totally in keeping with the conclusions of two released huge RCTs 136668-42-3 IC50 [21 lately,22]. Neither from the above two Cochrane testimonials focused on the result of HFOV in exclusive adults with ARDS. Since two huge scale RCTs evaluating HFOV with CMV as a short treatment for exclusive adult ARDS sufferers have been lately released, a meta-analysis was performed by us of RCTs, to systematically examine the safety and efficiency of HFOV in 136668-42-3 IC50 the populace of adult ARDS individual weighed against CMV. Methods and components Ethics declaration We performed a meta-analysis of released RCTs 136668-42-3 IC50 evaluating HFOV with CMV for ALI/ARDS in exclusive adult sufferers. All analyses had been based on released data extracted through the six eligible research, which were accepted by the Institutional Review Committee on Human Research. An additional file shows this in more detail (see Additional file 1). Additionally, as described in the six primary studies, all patients (or their representatives) enrolled in these six trials have provided written informed consent before any study-related procedure was performed. Therefore, the present meta-analysis does 136668-42-3 IC50 not present any further problems in relation to ethics or conflicts of interest. Literature search and identification of the publications To identify all published RCTs comparing HFOV with CMV in adult ARDS patients, a search of electronic databases (including PubMed, MedLine, Springer Link, Elsevier Science Direct, ISI web of knowledge, and EMBASE) was carried out with the next terms: severe respiratory distress symptoms; acute lung damage; high regularity oscillation ventilation..