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High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure

Jaballah, Nejla Ben MD; Khaldi, Ammar MD; Mnif, Khaled MD; Bouziri, Asma MD; Belhadj, Sarra MD; Hamdi, Asma MD; Kchaou, Wassim MD

Pediatric Critical Care Medicine: July 2006 - Volume 7 - Issue 4 - p 362-367
doi: 10.1097/01.PCC.0000227108.38119.2E
Clinical Investigations

Objective: To evaluate the effectiveness of high-frequency oscillatory ventilation (HFOV) in pediatric patients with acute respiratory failure, failing conventional ventilation.

Design: A prospective, clinical study.

Setting: Tertiary care pediatric intensive care unit.

Patients: Twenty pediatric patients (ages 12 days to 5 yrs) with acute respiratory failure (pneumonia, 14; sepsis with acute respiratory distress syndrome, 3; pulmonary edema as a complication of upper airway obstruction, 2; salicylate intoxication with acute respiratory distress syndrome, 1), failing conventional ventilation (median alveolar-arterial oxygen difference [P(a-a)o2] 578 [489–624] torr, median oxygenation index 26 [21–32].

Interventions: HFOV was instituted after a median length of conventional ventilation of 15.5 (3.3–43.5) hrs.

Measurements and Main Results: Ventilator settings, arterial blood gases, oxygenation index, and P(a-a)o2 were recorded before HFOV (0 hrs) and at predetermined intervals during HFOV and compared using the one-way Friedman rank-sum procedure and a two-tailed Wilcoxon matched-pairs test. Initiation of HFOV caused a significant decrease in Fio2 at 1 hr that continued to 24 hrs (p ≤ .04). In all patients, target ventilation was achieved, and 19 had improved oxygenation. After 1 hr, Paco2 significantly decreased (p = .002) and remained within the target range thereafter. There were significant decreases in P(a-a)o2 and oxygenation index at 1 and 4 hrs, respectively, that were sustained up to 12 hrs (p ≤ .04). No significant complications associated with HFOV were detected. Fifteen patients (75%) survived to hospital discharge. Only one patient died from respiratory failure.

Conclusions: In pediatric patients with acute respiratory failure, failing conventional ventilation, HFOV improves gas exchange in a rapid and sustained fashion. However, randomized controlled trials are needed to identify its benefits over conventional modes of mechanical ventilation.

From the Pediatric Intensive Care Unit, Children’s Hospital of Tunis, Tunis, Tunisia.

No financial support was used for the study.

The authors have not disclosed any potential conflicts of interest.

©2006The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies