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Abstract O-39: FEASIBILITY, SAFETY AND EFFICACY OF A NOVEL HIGH – FREQUENCY OSCILLATORY VENTILATION APPROACH IN PEDIATRIC ACUTE HYPOXEMIC RESPIRATORY FAILURE

Kneyber, M.C.J.1,2; De Jager, P.1; Kamp, T.1; Dijkstra, S.K.1; Burgerhof, J.3; Markhorst, D.G.4; Curley, M.A.Q.5; Cheifetz, I.M.6

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 17
doi: 10.1097/01.pcc.0000537381.69461.d2
Oral Abstracts
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1Beatrix Children’s Hospital, Department of Paediatrics- division of Paediatric Critical Care Medicine, Groningen, The Netherlands

2University of Groningen, Critical care- Anaesthesiology- Peri-operative & Emergency medicine, Groningen, The Netherlands

3University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands

4VU university medical center, Department of Paediatrics- division of Paediatric Critical Care Medicined, Amsterdam, The Netherlands

5Perelman School of Medicine- University of Pennsylvania, Family and Community Health- School of Nursing- Anesthesia and Critical Care Medicine- Perelman School of Medicine, Philadelphia, USA

6Duke University School of Medicine, Department of Pediatrics- Division of Critical Care Medicine, Durham, USA

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Aims & Objectives:

The current approach to high-frequency oscillatory ventilation (HFOV) management may negate any potential beneficial effect. The objective of this study was to report the feasibility, safety and efficacy of a novel individualized, physiology-based approach to HFOV in pediatrics that makes use of the open-lung concept by a staircase incremental-decremental mean airway pressure (mPaw) titration, high initial frequency (F) of 12 Hz and power to initially target an amplitude (ΔP) of 70–90 cmH2O, irrespective of age or weight.

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Methods

This study is a prospective observational cohort study of 115 non-cardiac patients < 18 years with acute hypoxemic respiratory failure (AHRF) receiving HFOV admitted to a 20-bed medical-surgical pediatric intensive care unit in a university children’s hospital between 2012 and 2015.

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Results

With our novel approach, it was possible to maintain high F (≥ 8 Hz) and high ΔP without compromising hemodynamics (heart rate, mean arterial blood pressure, central venous pressure). Cumulative fluid challenges or fluid balance were not negatively affected after transition from conventional mechanical ventilation (CMV) to HFOV, nor was there an increase in inotrope score. There was no increase in organ dysfunction or increased need for sedatives after introduction of HFOV. These findings were irrespective of age or pediatric acute respiratory distress syndrome (PARDS) severity.

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Conclusions

This is the first report showing feasibility, safety in terms of hemodynamics and efficacy of an individualized, open-lung, high-frequency approach to HFOV in PARDS. This novel, physiology-based approach requires further study to evaluate the effect on patient outcomes.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies