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

El-Nawawy, Ahmed; Moustafa, Azza A; Heshmat, Hassan; Abouahmed, Ahmed

doi:10.24953/turkjped.2017.02.004

Cited by 17 publications

(29 citation statements)

References 61 publications

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“…45 More recently, a Turkish RCT of 200 children with PARDS found that HFOV improved oxygenation but showed no difference in mortality, duration of mechanical ventilation, or length of stay (LOS), compared to CMV. 29 Consistent with other studies, the most common cause of death was multiorgan dysfunction rather than refractory hypoxemia. A metaanalysis of 6 RCTs with a total of 246 PARDS patients also demonstrated improved oxygenation with no significant difference in mortality or duration of mechanical ventilation.…”

Section: High-frequency Ventilationsupporting

confidence: 88%

“…Cheifetz, 20 El-Nawawy et al, 29 Ferguson et al, 41 Young et al, 42 Arnold et al, 43 Gupta et al, 44 Bateman et al, 45 Qiao et al 46 Prone positioning 50% Mortality reduction in severe ARDS (single RCT). Adult systematic reviews report improved oxygenation, safe, potential mortality reduction when coupled with other lung protective strategies.…”

Section: Rimensberger Andmentioning

confidence: 99%

“…20 To minimize the potential toxicity of ventilatory support required to oxygenate and ventilate PARDS patients, permissive hypoxemia and hypercapnia should be considered. Given that improved oxygenation has not been shown to improve outcomes, 22,[27][28][29] PALICC recommends oxygen saturation goals of 92%-97% for mild PARDS and 88%-92% and PEEP >10 cm H 2 O for severe PARDS. 20 In patients Tamburro and Kneyber, 53 Day et al, 63 Dobyns et al, 64 Ibrahim et al, 65 Afshari et al, 66 Bhalla et al 67…”

Section: Lung-protective Ventilationmentioning

confidence: 99%

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The Current State of Pediatric Acute Respiratory Distress Syndrome

Orloff

Turner

Rehder

2019

Pediatric Allergy, Immunology, and Pulmonology

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Pediatric acute respiratory distress syndrome (PARDS) is a significant cause of morbidity and mortality in children. Children with PARDS often require intensive care admission and mechanical ventilation. Unfortunately, beyond lung protective ventilation, there are limited data to support our management strategies in PARDS. The Pediatric Acute Lung Injury Consensus Conference (PALICC) offered a new definition of PARDS in 2015 that has improved our understanding of the true epidemiology and heterogeneity of the disease as well as risk stratification. Further studies will be crucial to determine optimal management for varying disease severity. This review will present the physiologic basis of PARDS, describe the unique pediatric definition and risk stratification, and summarize the current evidence for current standards of care as well as adjunctive therapies.

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Section: High-frequency Ventilationsupporting

confidence: 88%

Section: Rimensberger Andmentioning

confidence: 99%

Section: Lung-protective Ventilationmentioning

confidence: 99%

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The Current State of Pediatric Acute Respiratory Distress Syndrome

Orloff

Turner

Rehder

2019

Pediatric Allergy, Immunology, and Pulmonology

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“…Dos 307 ensaios clínicos randomizados identificados nas bases de dados, nove (n = 9) cumpriram os critérios e foram incluídos para a composição desta revisão. Fluxograma descrevendo as fases da pesquisa está representado na Figura 1. No que se refere à aplicabilidade da VOAF, a maior parte dos estudos incluídos discorre sobre a comparação dessa modalidade ventilatória à ventilação mecânica convencional 11,12,13,15,16 . Os principais desfechos utilizados foram a ocorrência de displasia broncopulmonar, retinopatia da prematuridade, hemorragia peri-intraventricular, variáveis gasométricas, tempo de ventilação mecânica invasiva, mortalidade e variáveis de oxigenação, em diversas condições clínicas.…”

Section: Resultsunclassified

Ventilação Oscilatória de Alta Frequência em Neonatologia e Pediatria: uma revisão sistemática

Silva

Costa

Bezerra

et al. 2020

http://www.uel.br/revistas/uel/index.php/rebrafis/index

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Introdução: Dentre as estratégias de ventilação protetora em Pediatria e Neonatologia, a Ventilação Oscilatória de Alta Frequência (VOAF) tem sido descrita como um modo ventilatório capaz de oferecer ventilação e oxigenação adequadas através de altas frequências oscilatórias. Objetivo: Agregar uma análise robusta sobre as indicações da VOAF nas populações pediátrica e neonatal, através de uma revisão sistemática e descrever seus desfechos analisando também o tempo de instalação da VOAF. Métodos: Revisão sistemática de Ensaios Clínicos Randomizados, publicados entre 2014 e 2018, nas bases de dados PubMED e MEDLINE. A busca foi realizada por dois pesquisadores independentes utilizando os Descritores em Ciências da Saúde (DeCS): High-Frequency Ventilation, Neonatology e Pediatrics e suas combinações pelos operadores booleanos AND e OR. A qualidade metodológica foi medida pelo escore da Physiotherapy Evidence Database (PEDro). Resultados: Foram identificados 307 artigos dentre as diferentes bases de dados e nove (9) cumpriram os critérios de elegibilidade. A revisão dos Ensaios Clínicos incluídos abrange a aplicabilidade da VOAF, sua utilização por meio de modalidade não invasiva, desfechos e algumas características a respeito do tempo de indicação da terapêutica. Conclusão: Os resultados encontrados abordam a VOAF através de estratégias ventilatórias invasivas e não invasivas, confrontando a VOAF com a Ventilação Mecânica convencional, onde a primeira exerce um efeito importante sobre os níveis de oxigenação e de pressão parcial de gás carbônico. Na forma não invasiva, a VOAF não demonstrou superioridade ao CPAP, porém configura-se como uma modalidade segura de ventilação não invasiva, tanto quanto as modalidades já consolidadas na literatura. A utilização da VOAF como modo de ventilação inicial tem sido questionada ao longo dos anos, porém os estudos mais recentes demonstram que a sua indicação de forma precoce, com os critérios de seleção bem estabelecidos e a adequada monitorização, mostra-se segura e eficaz.

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“…It is known that most patients with ARDS do not die due to severe hypoxemia but due to sequential organ function failure (SOFA) [21]. The SOFA score is an independent risk factor predicting death in ARDS [22].…”

Section: Discussionmentioning

confidence: 99%

Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children

Xie¹

2018

AJP

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To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO 2 ) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH 2 O vs. (9.9±1.6) cmH 2 O, P<0.01]. Cdyn and oxygenation index (OI) in the two groups were improved, and the degree of improvement in the treatment group was significantly higher than that in the control group [Cdyn after the experiment at 2 h: (0.39±0.03) mL/(cmH 2 O.kg) vs (0.36±0.03) mL/(cmH 2 O.kg), P<0.05; 24h: (0.40±0.03) mL/(cmH 2 O.kg) vs (0.38±0.03) mL/(cmH 2 O.kg), P<0.05; 48 h: (0.43±0.02) mL/(cmH 2 O.kg) vs. (0.40±0.02) mL/(cmH 2 O.kg), P<0.01; OI after the experiment at 24 h: (20.07±2.12) cmH 2 O/mmHg vs (21.94±2.05) cmH 2 O/mmHg, P<0.05; 48 h: (17.51±1.64) cmH 2 O/mmHg vs (19.82±2.07) cmH 2 O/mmHg, P<0.01]. There were no significant differences in heart rate, mean arterial pressure, and cardiac index before and after the experiment (all P>0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, P<0.05; 48 h: (76.67±9.23) ng/L vs (90.10±9.42) ng/L, P<0.01]. The length of mechanical ventilation and hospital stay in the PICU was significantly shorter in the treatment than in the control group [length of mechanical ventilation: (6.62±1.26) days vs (8.06±1.44) days; hospital stay in the PICU: (8.12±1.31) days vs (9.53±1.42) days, all P<0.05). There was no barotrauma and no difference in mortality between the two groups (P>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.

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

Cited by 17 publications

References 61 publications

The Current State of Pediatric Acute Respiratory Distress Syndrome

The Current State of Pediatric Acute Respiratory Distress Syndrome

Ventilação Oscilatória de Alta Frequência em Neonatologia e Pediatria: uma revisão sistemática

Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children

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