Pediatric Critical Care Medicine:
Abstracts of the 7th World Congress on Pediatric Critical Care
1Médecine néonatale et réanimation polyvalente, CHU de Reims, Reims, France 2Soins Intensifs Pédiatriques, CHU Sainte Justine, Montréal, Canada 3Faculté de Médecine, Université de Genève, Genève, Switzerland 4Pediatrics, College of Medecine, Hershey, USA 5Division of Critical Care Medicine, Main Hospital, Richmond, USA
Background and aims: Albeit promising lung-protective therapy, HFOV has not demonstrated any benefit over low-Vt conventional ventilation in pediatrics. Concerns have recently raised about HFOV safety in adults.
Aims: This international web-based survey assess stated endpoints used by intensivists to start and stop HFOV in pediatric ARDS.
Methods: We designed 3 clinical scenarios of pediatric ARDS varying by age and hemodynamic status. The case report form was elaborated and evaluated using the Delphi and Likert’s methods, respectively. For each scenario, the responder selected parameters (and their values) necessary to switch from conventional mechanical ventilation to HFOV, among those: pressure item (Positive end-expiratory pressure, Mean Airway Pressure, Peak Pressure, Plateau Pressure); Oxygenation item (PaO2, SpO2, FiO2, FiO2/PaO2 ratio, Oxygenation index); pH; PaCO2. The survey was sent 3 times to the mailing lists of the PALISI, ESPNIC and ANZICS networks. Descriptive statistical analysis was performed. The Ethical committee of Sainte-Justine Hospital, Montreal, Qc, Canada approved the study.
Results: 213 intensivists (37,5%) fullfilled the survey. 51% consider HFOV to be an early therapy, versus a rescue therapy for 49%. More than 70 different patterns are reported to trigger HFOV initiation. Peak Pressure, Plateau Pressure, FiO2, SpO2, pH and PCO2 are the most reported parameters. Age or hemodynamic compromise does not influence mean value of any item. The statement « early HFOV versus rescue HFOV» does not influence the threshold to initiate oscillatory ventilation.
Conclusions: Pediatric RCTs and guidelines are needed. Ventilation management should be protocolized in any trial about pediatric ARDS.