What is the role of high-frequency positive pressure ventilation (HFPPV) in the prevention of pulmonary interstitial emphysema (PIE)?

Updated: Jun 25, 2019
  • Author: Abhay J Bhatt, MD, MBBS; Chief Editor: Muhammad Aslam, MD  more...
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In a study comparing high-frequency positive pressure ventilation (HFPPV) to conventional mechanical ventilation (CMV), Pohlandt et al reported a reduction in the risk of PIE with HFPPV. [51] A meta-analysis by Greenough et al demonstrated that, compared to CMV, HFPPV was associated with a reduction in the risk of air leak, primarily pneumothorax, but not for PIE (typical relative risk [RR] for pneumothorax was 0.69; 95% confidence interval [CI]: 0.51-0.93). [52]

A review of different trials of elective high-frequency oscillatory ventilation (HFOV) versus CMV for acute pulmonary dysfunction in preterm infants suggested there may be an increase in the incidence of air leak syndromes, including but not limited to PIE in the HFOV group. [53]

In contrast, a prospective randomized multicenter study of HFOV versus CMV in premature infants with RDS showed no difference in the incidence of PIE. [24] Limited data regarding rescue HFOV for pulmonary dysfunction in the preterm infant also showed no difference in the rate of PIE. [54]  Similarly, Cochrane reviews of trials of elective high-frequency jet ventilation (HFJV) versus CMV for RDS demonstrated no significant difference in the incidence of air leak syndrome in the individual trials or in the overall analysis. [55]

In summary, the available literature suggests elective or rescue high-frequency ventilation does not prevent the development of PIE.

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