High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury

Rettig, Jordan S.; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C.; Bachman, Thomas E.; Bollen, Casper W.; Duval, Els L.I.M.; Gebistorf, Fabienne; Markhorst, Dick G.; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H.

doi:10.1097/ccm.0000000000001278

Cited by 36 publications

(48 citation statements)

References 21 publications

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“…We found that OI discriminated mortality better than the P/F ratio on day 1, which affirms the prognostic utility of incorporating MAP into bedside risk-stratification on ARDS Day 1. In children, both P/F ratio and OI have been associated with mortality (14, 15, 18, 19, 28), but to our knowledge, this is the first study to find that OI is more closely associated with mortality than is the P/F ratio on Day 1. This finding is consistent with the PALICC recommendation of OI as an important marker of ARDS severity (5).…”

Section: Discussionmentioning

confidence: 68%

“…Our findings are also consistent with a recently published study of children with ARDS undergoing high frequency oscillatory (HFO) ventilation, which reported that OI obtained immediately preceding HFO and underlying diagnosis are significant predictors of mortality. (15). However, the OI had been measured anywhere between 0 to 125 hours after initiation of mechanical ventilation (15).…”

Section: Discussionmentioning

confidence: 99%

“…(15). However, the OI had been measured anywhere between 0 to 125 hours after initiation of mechanical ventilation (15). …”

Section: Discussionmentioning

confidence: 99%

“…Among markers of oxygenation failure, both the P/F ratio and the oxygenation index (OI) have been correlated with mortality (13–15). Radiographic findings such as the Lung Injury Score show association with mortality, as do markers of global illness severity such as the Pediatric Risk of Mortality (PRISM) and Pediatric Logistic Organ Dysfunction (PELOD) scores (16–19).…”

Section: Introductionmentioning

confidence: 99%

“…Studies of pediatric ARDS completed after the ARDSNet trial of lower tidal volumes (1) have demonstrated that the P/F ratio and OI remain associated with mortality in the current era, and have further shown that the P/F ratio and OI measured between 24 hours to 3 days after ARDS onset are more robustly associated with mortality than values obtained at onset of ARDS (3, 4, 14, 16–19, 22). A recent publication has reported the utility of OI and underlying disease in predicting mortality among children undergoing high frequency oscillatory ventilation (15). However, the combined independent prognostic utility of these variables using multivariate models has not been assessed in an all-inclusive cohort of children with ARDS in recent era of widespread use of low tidal volume ventilation.…”

Section: Introductionmentioning

confidence: 99%

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A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*

Spicer

Calfee

Zinter

et al. 2016

Pediatric Critical Care Medicine

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Objective Despite declining mortality, ARDS is still involved in up to one third of pediatric intensive care deaths. The recently convened Pediatric Acute Lung Injury Consensus Conference has outlined research priorities for the field, which include the need for accurate bedside risk-stratification of patients. We aimed to develop a simple yet robust model of mortality risk among pediatric patients with ARDS to facilitate the targeted application of high-risk investigational therapies and stratification for enrollment in clinical trials. Design Prospective, multi-center cohort. Setting Five academic pediatric intensive care units. Patients 308 children ages >1 month and ≤ 18 years, admitted to the intensive care unit, with bilateral infiltrates on chest x-ray and P/F ratio <300 in the clinical absence of left atrial hypertension. Interventions None. Measurements and Main Results Twenty clinical variables were recorded in the following 6 categories: demographics, medical history, oxygenation, ventilation, radiographic imaging, and multi-organ dysfunction. Data were measured 0–24 and 48–72 hours after ARDS onset (Day 1 and Day 3) and examined for associations with hospital mortality. Among 308 enrolled patients, mortality was 17%. Children with a history of cancer and/or hematopoietic stem cell transplant (HSCT) had higher mortality (47% vs. 11%, p<0.001). Oxygenation index (OI), the P/F ratio, extrapulmonary organ dysfunction, PRISM-3, and positive cumulative fluid balance were each associated with mortality. Using two statistical approaches, we found that a parsimonious model of mortality risk using only OI and cancer/HSCT history performed as well as other more complex models that required additional variables. Conclusions In the pediatric intensive care unit, OI and cancer/HSCT history can be used on ARDS Day 1 or Day 3 to predict hospital mortality without the need for more complex models. These findings may simplify risk assessment for clinical trials, counseling families, and high-risk interventions such as extracorporeal life support.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

“…(15). However, the OI had been measured anywhere between 0 to 125 hours after initiation of mechanical ventilation (15). …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*

Spicer

Calfee

Zinter

et al. 2016

Pediatric Critical Care Medicine

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High frequency oscillatory ventilation in a cohort of children with respiratory failure

Stewart

Yehya

Lin

et al. 2018

Pediatric Pulmonology

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In this cohort of patients, use of HFOV for pediatric respiratory failure demonstrated a mortality rate in keeping with published data. The presence of an immunocompromised condition was a risk factor for mortality in severe respiratory failure with SCT recipients having the lowest survival rate. The OI at 24 h was the best predictor of mortality, especially in immunocompromised and SCT patients.

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A twelve‐year neonatal and pediatric high‐frequency oscillatory ventilation transport experience

Piloquet

Genuini

Kessous

et al. 2020

Pediatric Pulmonology

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Objective To describe the evolution over a 12‐year period of a pediatric intensive care unit transport team's (PICU‐TT) experience of pediatric and neonatal interhospital transportation on high‐frequency oscillation ventilation (HFOV). Methods This was a monocentric retrospective observational study from January 2006 to December 2017. All patients aged under 18 years old who were transported on HFOV by the Robert Debré Hospital PICU‐TT were included. Results Over a 12‐year period, 125 patients were transported on HFOV, including 107 newborns and 18 children. Median (range) age and weight were 9 days (1 h–9 years) and 3.3 (0.6–39) kg, respectively. Initial median oxygenation index, SpO2/FiO2 ratio and mean airway pressure were 32, 91, and 18 cmH2O, respectively, without significant difference between values before and after transport. Adverse events occurred during 28 transportations (22%) including three recovered cardiac arrests and one death. Overall survival rate at discharge was 74%, 78% in neonates and 56% in pediatrics, respectively. HFOV transportation rate increased over the last four years of the study for neonates and remained stable for older children. Extra‐corporeal membrane oxygenation (ECMO) initiation rate on arrival decreased and survival rate increased significantly during the last four years of the study (p < .05). Conclusion This study showed the feasibility of HFOV transportation by a PICU‐TT, despite some challenges. A trend towards using ECMO more than HFOV for the most severe respiratory and/or circulatory failures was seen over the 12‐year period. The HFOV transportation rate has increased for less severe neonatal patients.

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High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury

Cited by 36 publications

References 21 publications

A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*

A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*

High frequency oscillatory ventilation in a cohort of children with respiratory failure

A twelve‐year neonatal and pediatric high‐frequency oscillatory ventilation transport experience

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