High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis.
OBJECTIVE
To describe the time course of high frequency oscillatory ventilation (HFOV) in respiratory syncytial virus (RSV) bronchiolitis.


METHODS
Retrospective charts review.


METHODS
A tertiary paediatric intensive care unit.


METHODS
Infants with respiratory failure due to RSV infection.


METHODS
HFOV.


RESULTS
Pattern of lung disease, ventilatory settings, blood gases, infant's vital parameters, sedation and analgesia during the periods of conventional mechanical ventilation (CMV, 6 infants), after initiation of HFOV (HFOVi, 9 infants), in the middle of its course (HFOVm), at the end (HFOVe) and after extubation (Post-Extub) were compared. All infants showed a predominant overexpanded lung pattern. Mean airway pressure was raised from a mean (SD) 12.5 (2.0) during CMV to 18.9 (2.7) cmH(2)O during HFOVi (P < 0.05), then decreased to 11.1(1.3) at HFOVe (P < 0.05). Mean FiO(2) was reduced from 0.68 (0.18) (CMV) to 0.59 (0.14) (HFOVi) then to 0.29 (0.06) (P < 0.05) at HFOVe and mean peak to peak pressure from 44.9 (12.4) cmH(2)O (HFOVi) to 21.1 (7.7) P < 0.05 (HFOVe) while mean (SD) PaCO(2) showed a trend to decrease from 72 (22) (CMV) to 47 (8) mmHg (HFVOe) and mean infants respiratory rate a trend to increase from 20 (11) (HFOVi) to 34 (14) (HFOVe) breaths/min. With usual doses of sedatives and opiates, no infant was paralysed and all were extubated to CPAP or supplemental oxygen after a mean of 120 h.


CONCLUSIONS
RSV induced respiratory failure with hypercapnia can be managed with HFOV using high mean airway pressure and large pressure swings while preserving spontaneous breathing.
Berner
Michel E
ME
Neonatology and Paediatric Intensive Care Service, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. michel.berner@hcuge.ch
Hanquinet
Sylviane
S
Rimensberger
Peter C
PC
D001794:Blood Pressure; D001990:Bronchiolitis, Viral / Q000628:therapy*; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008499:Medical Records; D018357:Respiratory Syncytial Virus Infections / Q000628:therapy*; D018113:Respiratory Syncytial Virus, Human; D012189:Retrospective Studies