title: Hemodynamic effects of high-frequency oscillatory ventilation in severe pediatric respiratory failure.
abstract: OBJECTIVE
  To assess the hemodynamic effects of high mean proximal airway pressures (Paw) during high-frequency oscillatory ventilation (HFOV) in non-neonatal pediatrics patients with severe respiratory failure.
  
  
  METHODS
  Prospective and retrospective study.
  
  
  METHODS
  Pediatric ICU in a university-affiliated hospital.
  
  
  METHODS
  8 non-neonatal pediatric patients with severe respiratory failure ventilated with HFOV at our institution between July 1991 and February 1994. All patients had a pulmonary artery catheter.
  
  
  METHODS
  HFOV.
  
  
  RESULTS
  Higher Paw was required during HFOV to obtain adequate lung expansion during the first 24 h (median 20.9 cmH2O, range 16.9-30.0 cmH2O in CMV, versus median 30.0 cmH2O, range 21.0-33.0 cmH2O in HFOV, p = 0.008), resulting in improved oxygenation as evaluated by alveolar-arterial oxygen difference (median of 557.2 mmHg, range 360.4-607.8 mmHg in CMV, versus median of 410.5 mmHg, range 282.9-550.2 mmHg after 24 h of HFOV, p = 0.03). The only observed effect on the cardiovascular system was a decrease in heart rate (median of 162, range 129-178 in CMV, versus median of 142, range 104-195 after 24 h of HFOV, p = 0.03). Oxygen delivery, cardiac index, mean systemic arterial blood pressure, and pulmonary and systemic vascular resistances did not change significantly before and after HFOV in the patients as a group, although in one case a decrease in cardiac index and oxygen delivery was observed.
  
  
  CONCLUSIONS
  High-Paw HFOV must be used cautiously, but seems to have no discernible adverse effects on the cardiovascular system in most patients.
authors.affiliation: Children's Medical Center of Dallas, PICU Office, TX 75235, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Gutiérrez
authors.forename: D L
authors.initials: DL
authors.lastname: Levin
authors.forename: L O
authors.initials: LO
authors.lastname: Toro-Figueroa
mesh_terms: D000704:Analysis of Variance; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D006439:Hemodynamics; D006612:High-Frequency Ventilation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D010313:Partial Pressure; D011312:Pressure / Q000009:adverse effects*; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies