Skin breakdown in children and high-frequency oscillatory ventilation.
OBJECTIVE
To investigate the relationship of high-frequency oscillatory ventilation (HFOV) to skin breakdown on the scalp and ears in mechanically ventilated children.


METHODS
Retrospective cohort study of 32 patients supported with HFOV paired with 32 patients supported with conventional mechanical ventilation (CV) in a pediatric intensive care unit (PICU).


RESULTS
By univariate analysis, more HFOV patients had skin breakdown than did the CV patients (53% vs 12.5%, p=.001); HFOV patients also had greater severity of illness (Pediatric Risk of Mortality scores), higher mortality, and longer durations of neuromuscular blockade, low systolic blood pressure, and time exposed to risk. Life table analysis demonstrated no difference in the rate of skin breakdown between HFOV and CV patients. Multifactorial analysis showed that only PICU time at risk was a risk factor for skin breakdown.


CONCLUSIONS
HFOV was not an independent risk factor for the development of skin breakdown. PICU time at risk was the sole risk factor for the development of skin breakdown in all mechanically ventilated patients in the PICU.
Schmidt
J E
JE
Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, USA.
Berens
R J
RJ
Zollo
M B
MB
Weisner
M
M
Weigle
C G
CG
D000704:Analysis of Variance; D002675:Child, Preschool; D004423:Ear; D005260:Female; D006612:High-Frequency Ventilation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007223:Infant; D015993:Life Tables; D008297:Male; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012535:Scalp; D012883:Skin Ulcer / Q000209:etiology*; D016019:Survival Analysis; D013997:Time Factors