• Sachin Sud, Maneesh Sud, Jan O Friedrich, Maureen O Meade, Niall D Ferguson, Hannah Wunsch, and Neill K J Adhikari.
• Critical Care Medicine Program, Interdepartmental Division of Critical Care, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada, M5G 2N2.
• BMJ. 2010 Jan 1;340:c2327.

ObjectiveTo determine clinical and physiological effects of high frequency oscillation compared with conventional ventilation in patients with acute lung injury/acute respiratory distress syndrome (ARDS).DesignSystematic review and meta-analysis.Data SourcesElectronic databases to March 2010, conference proceedings, bibliographies, and primary investigators.Study SelectionRandomised controlled trials of high frequency oscillation compared with conventional ventilation in adults or children with acute lung injury/ARDS. Data selection Three authors independently extracted data on clinical, physiological, and safety outcomes according to a predefined protocol. We contacted investigators of all included studies to clarify methods and obtain additional data. Analyses used random effects models.ResultsEight randomised controlled trials (n=419 patients) were included; almost all patients had ARDS. Methodological quality was good. The ratio of partial pressure of oxygen to inspired fraction of oxygen at 24, 48, and 72 hours was 16-24% higher in patients receiving high frequency oscillation. There were no significant differences in oxygenation index because mean airway pressure rose by 22-33% in patients receiving high frequency oscillation (PConclusionHigh frequency oscillation might improve survival and is unlikely to cause harm. As ongoing large multicentre trials will not be completed for several years, these data help clinicians who currently use or are considering this technique for patients with ARDS.

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