Comparison of High-Frequency Oscillatory Ventilation and Conventional Mechanical Ventilation in Pediatric Respiratory Failure

Gupta, Punkaj; Green, Jerril W.; Tang, Xinyu; Gall, Christine M.; Gossett, Jeffrey M.; Rice, Tom; Kacmarek, Robert M.; Wetzel, Randall C.

doi:10.1001/jamapediatrics.2013.4463

Cited by 86 publications

(90 citation statements)

References 26 publications

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“…Although these data support an earlier report of negative outcomes associated with HFOV in children and are consistent with adult HFOV trials, many questions remain (6,7,9). With oxygenation data included in the propensity matching, these data provide a stronger case against HFOV and address a major criticism levied against the study by Gupta and colleagues (10)(11)(12).…”

Section: Discussionsupporting

confidence: 73%

“…In neonates, a meta-analysis of randomized controlled trials concluded that the use of early HFOV, within 24-48 hours of admission, was at least as effective as CMV (8). In the absence of comparable pediatric trials, data from the virtual pediatric intensive care unit (PICU) were recently used to compare outcomes in patients supported on HFOV or CMV (9). Propensity scoring was used to match the two groups on severity of illness and admission diagnoses.…”

mentioning

confidence: 99%

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Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis

Bateman

Borasino

Asaro³

et al. 2016

Am J Respir Crit Care Med

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Rationale: The use of high-frequency oscillatory ventilation (HFOV) for acute respiratory failure in children is prevalent despite the lack of efficacy data.Objectives: To compare the outcomes of patients with acute respiratory failure managed with HFOV within 24-48 hours of endotracheal intubation with those receiving conventional mechanical ventilation (CMV) and/or late HFOV.Methods: This is a secondary analysis of data from the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) study, a prospective cluster randomized clinical trial conducted between 2009 and 2013 in 31 U.S. pediatric intensive care units. Propensity score analysis, including degree of hypoxia in the model, compared the duration of mechanical ventilation and mortality of patients treated with early HFOV matched with those treated with CMV/late HFOV.Measurements and Main Results: Among 2,449 subjects enrolled in RESTORE, 353 patients (14%) were ever supported on HFOV, of which 210 (59%) had HFOV initiated within 24-48 hours of intubation. The propensity score model predicting the probability of receiving early HFOV included 1,064 patients (181 early HFOV vs. 883 CMV/late HFOV) with significant hypoxia (oxygenation index >8). The degree of hypoxia was the most significant contributor to the propensity score model. After adjusting for risk category, early HFOV use was associated with a longer duration of mechanical ventilation (hazard ratio, 0.75; 95% confidence interval, 0.64-0.89; P = 0.001) but not with mortality (odds ratio, 1.28; 95% confidence interval, 0.92-1.79; P = 0.15) compared with CMV/late HFOV. Conclusions:In adjusted models including important oxygenation variables, early HFOV was associated with a longer duration of mechanical ventilation. These analyses make supporting the current approach to HFOV less convincing.

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Section: Discussionsupporting

confidence: 73%

mentioning

confidence: 99%

Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis

Bateman

Borasino

Asaro³

et al. 2016

Am J Respir Crit Care Med

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“…On the other hand, a retrospective observational study concluded that application of early HFO was associated with worse outcomes and higher mortality among pediatrics with acute hypoxemic respiratory failure 41 ; however, that study was retrospective lacking randomization and missing data on certain key variables as PaO 2 , FiO 2 , PaO 2 /FiO 2 , presence or absence of air leaks and causes of death.…”

Section: Discussionmentioning

confidence: 99%

High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study

et al. 2017

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Although the HFO mode appeared to be a safe mode with a significant better oxygenation improvement (after the first 24 hours) and fewer crossover rates, it failed to show differences as regards mortality or LOS when compared to the CMV adopting protective lung strategy. In PARDS, HFO had a superior advantage in improving oxygenation, yet with no significant mortality improvement, as multi-organ dysfunction syndrome (MODS) was the most common cause of death in our study and not refractory hypoxemia which is the main problem in PARDS; highlighting that mortality in PARDS is multi-factorial and may not depend only on how fast oxygenation improves.

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“…A recent analysis of PICU practices by Gupta et al suggested that HFOV might not be effective; however, the conclusions and methods presented in the analysis by Gupta et al (16) have been meet with skepticism (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury

Rettig

Smallwood

Walsh

et al. 2015

Critical Care Medicine

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Given the number of centers and subjects included in the database, these findings provide a robust description of current practice regarding the use of high-frequency oscillatory ventilation for pediatric hypoxic respiratory failure. Patients with severe hypoxic respiratory failure and immunocompromise had the highest mortality risk, and those with respiratory syncytial virus had the lowest. A means of identifying the risk of 30-day mortality for subjects can be obtained by identifying the underlying disease and oxygenation index on conventional ventilation preceding the initiation of high-frequency oscillatory ventilation.

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Comparison of High-Frequency Oscillatory Ventilation and Conventional Mechanical Ventilation in Pediatric Respiratory Failure

Cited by 86 publications

References 26 publications

Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis

Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis

High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study

High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury

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