High-frequency oscillatory ventilation for infants and children with adult respiratory distress syndrome.
Two infants and two children suffered from severe hypoxemia, presenting as a ratio of arterial to alveolar PaO2 < 0.1, persisting for more than 3 hours in spite of high settings on conventional mechanical ventilator. Adult respiratory distress syndrome was diagnosed with the support of bilateral diffuse haziness on chest radiographs. High-frequency oscillatory ventilation with high-lung-volume strategy resulted in prompt decrease in oxygenation index and increase in ratio of arterial to alveolar P O2 in three (75%) of the 4 patients within 6 hours. After a mean duration of 96 hours, high-frequency oscillatory ventilation could be weaned off and conventional ventilation could be resumed at lower mean airway pressure in 3 patients. They continued to improve and finally recovered. The other one showed initially steady improvement on high-frequency oscillatory ventilation for 20 hours, but ultimately died of unresolved cytomegalovirus pneumonitis and intractable pulmonary hemorrhage. There were 2 episodes of pneumothorax developing during high-frequency oscillatory ventilation. After decreasing mean airway pressure and amplitude, the airleak resolved with chest tube insertion. We conclude that high-frequency oscillatory ventilation with high-lung-volume strategy may be an effective rescue therapy to relieve profound hypoxemia in infants and children with adult respiratory distress syndrome.
Tang
J R
JR
Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Yau
K I
KI
Shih
H H
HH
D002648:Child; D002675:Child, Preschool; D005260:Female; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy*; D013997:Time Factors
D010100:Oxygen