High-Frequency Oscillatory Ventilation in Pediatric Acute Hypoxemic Respiratory Failure: Disease-Specific Morbidity Survival Analysis

Babbitt, Christopher; Cooper, Michael C.; Nussbaum, Eliezer; Liao, Eileen; Levine, Glenn; Randhawa, Inderpal

doi:10.1007/s00408-012-9417-5

Cited by 10 publications

(29 citation statements)

References 32 publications

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“…By 24 hours, the PaO 2 was still increasing, but this was now accompanied by a substantial reduction in OI, perhaps adding weight to the calls for prognostication of PARDS patients at 24 hours post admission, rather than on admission. [2,12,13,[16][17][18]22,23] In Group B, the efficacy of HFOV in enhancing ventilation was substantial, with reductions in PaCO 2 producing a median pH of more than 7.25 at 60 minutes. The approach to setting amplitude was the same as that in Group A, but the initial frequency was set 2 Hz lower, to facilitate CO 2 elimination.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12]17] Paw has then been titrated based on oxygenation and chest inflation on radiograph. [2][3][4]10,12,14,18,19] The initial frequency has been guided by the age and weight of the patient, with values ranging between 5 and 10 Hz for patients weighing ≥10 kg, and 10 and 15 Hz for patients weighing ˂10 kg. [2][3][4]8,10,11,17,18,20] Strategies to set amplitude have used 'chest wall wiggle' , with subsequent titration, together with frequency if required, to achieve a PaCO 2 target.…”

mentioning

confidence: 99%

“…[2][3][4]8,10,11,17,18,20] Strategies to set amplitude have used 'chest wall wiggle' , with subsequent titration, together with frequency if required, to achieve a PaCO 2 target. [2,[10][11][12]14,18] Reported triggers prompting transition back to CMV have also varied widely, with the use of objective criteria for Paw (10 -20 cmH 2 O) and FiO 2 (≤0.5), as well as the more subjective criterion of absence of significant desaturation with suctioning. [11,12,18,20] Two years' experience in managing paediatric patients with respiratory failure using HFOV in a tertiary paediatric intensive care unit (PICU) is presented in the present study.…”

mentioning

confidence: 99%

“…[2,[10][11][12]14,18] Reported triggers prompting transition back to CMV have also varied widely, with the use of objective criteria for Paw (10 -20 cmH 2 O) and FiO 2 (≤0.5), as well as the more subjective criterion of absence of significant desaturation with suctioning. [11,12,18,20] Two years' experience in managing paediatric patients with respiratory failure using HFOV in a tertiary paediatric intensive care unit (PICU) is presented in the present study. The objectives were to describe the population of patients in which HFOV was used, the triggers used for initiation of and transitioning from HFOV and the initial settings of HFOV.…”

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confidence: 99%

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High-frequency oscillatory ventilation in a tertiary paediatric intensive care unit in an academic hospital in Johannesburg, South Africa

Cawood

Naidoo

2019

S Afr J Crit Care

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Conventional mechanical ventilation (CMV) is sometimes unable to achieve adequate gas exchange, necessitating the use of nonconventional ventilatory strategies. The recent Pediatric Acute Lung Injury Consensus Conference (PALICC) recommended the use of high frequency oscillatory ventilation (HFOV) in severe paediatric acute respiratory distress syndrome (PARDS) as an alternative (or rescue) ventilatory mode. [1] Reported use of HFOV in critically ill children varies between 3% and 30%. [2-4] Despite the putative benefits of HFOV, randomised controlled trials in paediatrics demonstrating the superiority of HFOV over conventional modes are scarce, so the role of HFOV remains confined to use as salvage within recent paediatric mechanical ventilation guidelines. [1,5] HFOV has come under scrutiny with the recent publication of two large trials looking at HFOV in adults with moderate to severe acute respiratory distress syndrome. The lack of benefit found, as well as concerns regarding potential harm, have prompted deliberations around its continued use. [6,7] Practices around HFOV use vary, and may need to be refined. [4] HFOV has generally been considered a rescue strategy, and as such, the optimum timing of initiation is unclear. [8,9] The most commonly used triggers to transition from CMV to HFOV are both markers of oxygenation, namely the PaO 2 :FiO 2 (PF) ratio and the oxygenation index (OI); however, a wide range of values for both parameters has been reported. [10-14] Generally, HFOV is suggested when oxygenation remains severely impaired (SpO 2 <88% and/or PaO 2 <50 mmHg with a FiO 2 >0.6) despite maximal lung-protective CMV limiting peak pressures to less than 30-35 cmH20 with sufficient positive end-expiratory pressure

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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High-frequency oscillatory ventilation in a tertiary paediatric intensive care unit in an academic hospital in Johannesburg, South Africa

Cawood

Naidoo

2019

S Afr J Crit Care

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“…11,12 Historically, survival rates in children with HRF managed with HFOV vary from 40 to 80%. [13][14][15][16] To date, there is no universally accepted method to predict who may benefit from and survive this therapy, which could assist in deploying additional treatments in the attempt to improve outcomes. Extracorporeal membrane oxygenation (ECMO) is increasingly used for children with severe HRF, most frequently in those who can no longer be supported by CMV using noninjurious settings.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Survival during High-Frequency Oscillatory Ventilation in Children

Raj

Slaven

Rigby

2015

J Pediatr Intensive Care

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Objectives: To determine indicators of survival in children with severe hypoxic respiratory failure (HRF) after transition to high frequency oscillatory ventilation (HFOV). Methods:Single center retrospective examination of children with HRF who were transitioned to HFOV. Blood gases and ventilator settings 24 hours prior to and 48 hours after HFOV in survivors and non-survivors were evaluated.Results: Sixty two children with mean age of 7 years and mean weight of 26 kg were included with an observed mortality of 29%. Mean airway pressures (Paw), oxygenation index (OI), PaO2/FiO2 oxygen (P/F) ratio, pH, bicarbonate and PaCO2 were similar prior to HFOV in survivors and non-survivors. During HFOV, mean OI and P/F ratio improved in both groups with an average Paw increase of ~10 cm of H2O. Survivors had lower OI than non-survivors (21±0.9 versus 26.5±2.2; p<0.01) beginning 24 hours after HFOV. P/F ratio appears to diverge by 36 hours, with survivors having P/F ratio >200. Survivors had higher pH than non-survivors at 36 hours (7.40±0.01 versus 7.32±0.02; p<0.05), higher bicarbonate levels (27.1±0.7 versus 23.9±1.3 mEq/L) and similar PaCO2 with less oscillatory support (i.e., hertz and amplitude). Inhaled nitric oxide (iNO) was used in 53% of patients with improvements in oxygenation but with no effect on mortality.Conclusions: HFOV improves oxygenation in children with severe HRF. Non-survivors can be distinguished from survivors at 24-36 hours during HFOV by higher OI, metabolic acidosis, and higher oscillatory support. These data may assist in prognostication or timing of initiating alternative therapies, such as extracorporeal membrane oxygenation.

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High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure

et al. 2013

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Summary Background Airway pressure release ventilation (APRV) and high frequency oscillatory ventilation (HFOV) are frequently used in acute lung injury (ALI) refractory to conventional ventilation. Our aim was to describe our experience with APRV and HFOV in refractory pediatric ALI, and to identify factors associated with survival. Methods We analyzed 104 patients with hypoxemia refractory to conventional ventilation transitioned to either APRV or HFOV. Demographics, oxygenation index (OI), and PaO2/FiO2 (PF ratio) were recorded before transition to either mode of nonconventional ventilation (NCV) and for every 12 hr after transition. Results Relative to APRV, patients on HFOV were younger and had more significant lung disease evidenced by higher OI (28.5 [18.6, 36.2] vs. 21.0 [15.5, 30.0], P = 0.008), lower PF ratios (73 [59,94] vs. 99 [76,131], P = 0.002), and more frequent use of inhaled nitric oxide. In univariate analysis, HFOV was associated with more frequent neuromuscular blockade. Forty-one of 104 patients died on NCV (39.4%). Survivors demonstrated improvement in OI 24 hr after transition to NCV, whereas non-survivors did not (12.9 [8.9, 20.9] vs. 28.1 [17.6, 37.1], P < 0.001). After controlling for immunocompromised status, number of vasopressors, and OI before transition, mode of NCV was not associated with mortality. Conclusions In a heterogeneous PICU population with hypoxemia refractory to conventional ventilation transitioned to NCV, improvement in oxygenation at 24 hr was associated with survival. Immunocompromised status, number of vasopressor infusions, and the OI before transition to NCV were independently associated with survival.

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High-Frequency Oscillatory Ventilation in Pediatric Acute Hypoxemic Respiratory Failure: Disease-Specific Morbidity Survival Analysis

Abstract: High-frequency oscillatory ventilation may be safely utilized. It has a 66 % overall survival rate in pediatric AHRF of various etiologies. Patients with morbidity limited to the respiratory system and optimized oxygenation indices are most likely to survive on HFOV.

Cited by 10 publications

References 32 publications

High-frequency oscillatory ventilation in a tertiary paediatric intensive care unit in an academic hospital in Johannesburg, South Africa

High-frequency oscillatory ventilation in a tertiary paediatric intensive care unit in an academic hospital in Johannesburg, South Africa

Factors Associated with Survival during High-Frequency Oscillatory Ventilation in Children

High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure

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