High-frequency oscillatory ventilation in paediatric patients with acute respiratory distress syndrome--early rescue use.
In order to determine the response to high-frequency oscillatory ventilation (HFOV), used as an "early rescue" therapy, in a cohort of paediatric patients with acute respiratory distress syndrome (ARDS), a prospective clinical study was performed in a tertiary care paediatric intensive care unit. Ten consecutive patients, aged 12 days to 5 years with ARDS and hypoxaemic respiratory failure on conventional ventilation (CV), using a lung protective strategy, were managed with HFOV early in the course of the disease process (median length of CV 4 h). Arterial blood gases, oxygenation index (OI), alveolar-arterial oxygen difference (P(A-a)O2) and PaO2/FIO2 ratio were prospectively recorded prior to HFOV (0 h) and at predetermined intervals throughout the course of the HFOV protocol. There was a significant improvement in PaCO2 4 h after institution of HFOV (P = 0.012). A significant and sustained increase (P < 0.001) in PaO2/FIO2 ratio and a significant and sustained decrease (P < 0.001) in OI and P(A-a)O2 were demonstrated during the HFOV trial. These improvements were achieved 4 h after initiating HFOV (P < 0.05). Eight patients survived. There were no deaths from respiratory failure.


CONCLUSIONS
In paediatric patients with acute respiratory distress syndrome and hypoxaemic respiratory failure on conventional ventilation, using a lung protective strategy, high-frequency oscillatory ventilation used as an "early rescue" therapy, improves gas exchange in a rapid and sustained fashion and provides a good outcome. Use of this therapy should probably be considered early in the course of the disease process.
Paediatric Intensive Care Unit, Children's Hospital of Tunis, Place Bab Saadoun, 1007 Tunis, Tunisia. nejla.benjaballah@rns.tn
Nejla
N
Ben Jaballah
Khaled
K
Mnif
Asma
A
Bouziri
Kalthoum
K
Kazdaghli
Sarra
S
Belhadj
Bechir
B
Zouari
D002675:Child, Preschool; D005260:Female; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome