High-frequency oscillatory ventilation in children: a 10-year experience

• Author(s): Moniz, M ; Silvestre, C ; Nunes, P ; Abadesso, C ; Matias, E ; Loureiro, H ; Almeida, H
• Date: 2013
• Persistent ID: http://hdl.handle.net/10400.10/967
• Origin: Repositório do Hospital Prof. Doutor Fernando Fonseca
• Subject(s): High-frequency oscillatory ventilation; Child; Respiratory insufficiency; Insuficiência respiratória; Criança; Portugal; Pediatric intensive care unit; Unidade de cuidados intensivos pediátricos; Ventilação de alta frequência
• Document Type: Article
• Language: English

Description

OBJECTIVES: The aim of the study was to describe the experience with high-frequency oscillatory ventilation (HFOV) in a Portuguese Pediatric Critical Care Unit, and to evaluate whether HFOV allowed improvement in oxygenation and ventilation. METHODS: This was a retrospective observational cohort study of children ventilated by HFOV between January, 2002 and December, 2011. The following parameters were recorded: demographic and clinical data, and blood gases and ventilatory parameters during the first 48 hours of HFOV. RESULTS: 80 children were included, with a median age of 1.5 months (min: one week; max: 36 months). Pneumonia (n=50; 62.5%) and bronchiolitis (n=18; 22.5%) were the main diagnoses. Approximately 40% (n=32) of the patients developed acute respiratory distress syndrome (ARDS). Conventional mechanical ventilation was used in 68 (85%) of patients prior to HFOV. All patients who started HFOV had hypoxemia, and 56 (70%) also presented persistent hypercapnia. Two hours after starting HFOV, a significant improvement in SatO2/FiO2 ratio (128±0.63 vs. 163±0.72; p<0.001) that was sustained up to 24 hours of HFOV and a decrease in FiO2 were observed. Since the beginning of HFOV, the mean PCO2 significantly decreased (87±33 vs. 66±25; p<0.001), and the pH significantly improved (7.21±0.17 vs. 7.32±0.15; p<0.001). Overall survival was 83.8%. CONCLUSIONS: HFOV enabled an improvement in hypercapnia and oxygenation. It is a safe option for the treatment of ARDS and severe small airway diseases.