High-frequency oscillatory ventilation in pediatric patients.
BACKGROUND
High-frequency oscillatory ventilation (HFOV) is a ventilatory mode using small tidal volumes with low phasic pressures at supraphysiological frequencies. Beyond the neonatal period there are distinct lung diseases for which HFOV is used. Data of 35 children who deteriorated on conventional ventilation were retrospectively analysed in two tertiary pediatric intensive care units.


METHODS
Depending on the underlying pulmonary pathophysiology, three strategies were employed. First, the 'open-lung' strategy designed to rapidly recruit and maintain optimal lung volume in DAD (n=27) and pulmonary hemorrhage (n=5). Second, the 'low-volume' strategy in persistent air leak (n=1) where, after an initial identical approach, mean airway pressure (MAP) is reduced until the air leak ceases. Third, the 'open-airway' strategy in obstructive airway disease (n=5) where MAP is used to recruit and stent the airways.


RESULTS
Seven patients died, two due to respiratory failure. Three patients developed an air leak. Nine patients developed chronic lung disease. There was a significant decrease of the oxygenation index (OI) in the survivors. In the two patients who died of respiratory failure, the OI increased.


CONCLUSIONS
If certain conditions are met, HFOV appears a safe and effective mode of ventilation in pediatric respiratory failure.
Duval
E L
EL
Pediatric Intensive Care Unit, University Children's Hospital Het Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands.
Markhorst
D G
DG
Gemke
R J
RJ
van Vught
A J
AJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006612:High-Frequency Ventilation / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008171:Lung Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D009569:Nitric Oxide