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  • Systematic Review
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High-frequency oscillatory ventilation with volume guarantee in infants: a systematic review

Pediatric Research volume 98, pages 470–478 (2025)Cite this article

Abstract

Background

This systematic review was designed to assess the efficacy and safety of high-frequency oscillatory ventilation (HFOV) combined with volume guarantee (VG) in infants compared with HFOV alone.

Methods

We searched for electronic databases to find studies using HFOV-VG or HFOV for respiratory support in infants from the database creation to October 20, 2024. Two evaluators independently screened the literature, extracted data, and evaluated quality. Meta-analysis was performed using Rev man 5.3 software on survival-free BPD at grades 2 and 3 (SF-BPD), the incidence of BPD, mortality, duration of invasive ventilation, length of hospital stays, and complications in both groups.

Results

The review included 11 studies (three randomized controlled trials, one non-randomized controlled trial, and seven observational studies) with 785 participants. Data analysis showed that HFOV-VG could increase SF-BPD in preterm infants (OR 3.15, 95%CI 1.66–5.98) without reducing the overall incidence of BPD compared with HFOV alone. HFOV-VG may offer advantages in shortening the duration of MV and total hospital stay, potentially reducing mortality and the incidence of air leak syndrome.

Conclusions existing

Studies showed that HFOV-VG had certain advantages in improving oxygenation and stable ventilation to protect neonatal lungs. HFOV-VG could increase SF-BPD in preterm infants with GA < 32 weeks without reducing the overall incidence of BPD compared with HFOV alone.

Impact

  • Existing evidence suggested that HFOV-VG ventilation strategies could increase SF-BPD in preterm infants with GA < 32 weeks without reducing the overall incidence of BPD compared with HFOV alone.

  • HFOV-VG ventilation strategy has certain advantages in improving oxygenation and stable ventilation to protect neonatal lungs.

  • The effects of HFOV-VG vs. HFOV in neonates remain to be further validated by additional large sample, multicenter RCTs.

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Data availability

Source data for all figure(s) and number(s) are provided with the paper and supplementary files. Aggregate data are available from the corresponding author on reasonable request.

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Acknowledgements

Thanks to Dr Li for helpful comments on a draft version of this manuscript. The author(s) disclosed that no financial support was provided for the research, authorship and/or publication of this article.

Funding

This study is supported by Sanming Project of Medicine in Shenzhen (SZSM202211001), and Shenzhen Key Laboratory of Maternal and Child Health and Diseases (ZDSYS20230626091559006).

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Authors and Affiliations

  1. Departments of Neonatology, Women and Children’s Medical Center, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China

    Wanjiao Liu, Haifeng Zong & Chuanzhong Yang

  2. Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China

    Wanjiao Liu & Jin Jiang

  3. Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China

    Fang Li

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Contributions

Wanjiao Liu conceptualized and designed the study, accomplished the article-extracting and data analysis, and drafted the initial manuscript. Jin Jiang accomplished the article-extracting and risk assessment work. Hai Feng Zong completed the data extraction and designed the study. Fang Li and Chuanzong Yang revised the initial manuscript, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Chuanzhong Yang or Fang Li.

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Liu, W., Zong, H., Jiang, J. et al. High-frequency oscillatory ventilation with volume guarantee in infants: a systematic review. Pediatr Res 98, 470–478 (2025). https://doi.org/10.1038/s41390-025-03934-0

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