High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure.
OBJECTIVE
To evaluate the effectiveness of high-frequency oscillatory ventilation (HFOV) in pediatric patients with acute respiratory failure, failing conventional ventilation.


METHODS
A prospective, clinical study.


METHODS
Tertiary care pediatric intensive care unit.


METHODS
Twenty pediatric patients (ages 12 days to 5 yrs) with acute respiratory failure (pneumonia, 14; sepsis with acute respiratory distress syndrome, 3; pulmonary edema as a complication of upper airway obstruction, 2; salicylate intoxication with acute respiratory distress syndrome, 1), failing conventional ventilation (median alveolar-arterial oxygen difference [P(A-a)O2] 578 [489-624] torr, median oxygenation index 26 [21-32].


METHODS
HFOV was instituted after a median length of conventional ventilation of 15.5 (3.3-43.5) hrs.


RESULTS
Ventilator settings, arterial blood gases, oxygenation index, and P(A-a)O2 were recorded before HFOV (0 hrs) and at predetermined intervals during HFOV and compared using the one-way Friedman rank-sum procedure and a two-tailed Wilcoxon matched-pairs test. Initiation of HFOV caused a significant decrease in FiO2 at 1 hr that continued to 24 hrs (p <or= .04). In all patients, target ventilation was achieved, and 19 had improved oxygenation. After 1 hr, PaCO2 significantly decreased (p = .002) and remained within the target range thereafter. There were significant decreases in P(A-a)O2 and oxygenation index at 1 and 4 hrs, respectively, that were sustained up to 12 hrs (p <or= .04). No significant complications associated with HFOV were detected. Fifteen patients (75%) survived to hospital discharge. Only one patient died from respiratory failure.


CONCLUSIONS
In pediatric patients with acute respiratory failure, failing conventional ventilation, HFOV improves gas exchange in a rapid and sustained fashion. However, randomized controlled trials are needed to identify its benefits over conventional modes of mechanical ventilation.
Ben Jaballah
Nejla
N
Pediatric Intensive Care Unit, Children's Hospital of Tunis, Tunis, Tunisia.
Khaldi
Ammar
A
Mnif
Khaled
K
Bouziri
Asma
A
Belhadj
Sarra
S
Hamdi
Asma
A
Kchaou
Wassim
W
D000208:Acute Disease; D002675:Child, Preschool; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy*; D016019:Survival Analysis