title: High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury: A Multicenter International Experience.
abstract: OBJECTIVE
  We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillatory ventilation practice.
  
  
  METHODS
  Multicenter retrospective, observational questionnaire study.
  
  
  METHODS
  Seven PICUs.
  
  
  METHODS
  Demographic, disease factor, and ventilatory and outcome data were collected, and 328 patients from 2009 to 2010 were included in this analysis.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patients were classified into six cohorts based on underlying diagnosis. We used univariate analysis to identify factors associated with mortality risk and multivariate logistic regression to identify independent predictors of mortality risk. An oxygenation index greater than 35 and immunocompromise exhibited the greatest predictive power (p < 0.0001) for increased mortality risk, and respiratory syncytial virus was associated with lowest mortality risk (p = 0.003). Differences in mortality risk as a function of oxygenation index were highly dependent on primary underlying condition. A trend toward an increase in oscillator amplitude and frequency was observed when compared with historical data.
  
  
  CONCLUSIONS
  Given the number of centers and subjects included in the database, these findings provide a robust description of current practice regarding the use of high-frequency oscillatory ventilation for pediatric hypoxic respiratory failure. Patients with severe hypoxic respiratory failure and immunocompromise had the highest mortality risk, and those with respiratory syncytial virus had the lowest. A means of identifying the risk of 30-day mortality for subjects can be obtained by identifying the underlying disease and oxygenation index on conventional ventilation preceding the initiation of high-frequency oscillatory ventilation.
authors: 1Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2Children's Medical Center of Dallas, Dallas, TX. 3Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland. 4Czech Technical University in Prague, Kladno, Czech Republic. 5Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. 6Pediatric Intensive Care, Queen Paola Children's Hospital, Antwerp, Belgium. 7Division of Pediatric Intensive Care, Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands. 8The Hospital for Sick Children, Toronto, ON, Canada.
authors: Jordan S
authors: JS
authors: Rettig
authors: Craig D
authors: CD
authors: Smallwood
authors: Brian K
authors: BK
authors: Walsh
authors: Peter C
authors: PC
authors: Rimensberger
authors: Thomas E
authors: TE
authors: Bachman
authors: Casper W
authors: CW
authors: Bollen
authors: Els L
authors: EL
authors: Duval
authors: Fabienne
authors: F
authors: Gebistorf
authors: Dick G
authors: DG
authors: Markhorst
authors: Marcel
authors: M
authors: Tinnevelt
authors: Mark
authors: M
authors: Todd
authors: David
authors: D
authors: Zurakowski
authors: John H
authors: JH
authors: Arnold
mesh_terms: D001784:Blood Gas Analysis; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D011237:Predictive Value of Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors