title: A comparison of clinical efficacy between high frequency oscillatory ventilation and conventional ventilation with lung volume recruitment in pediatric acute respiratory distress syndrome: A randomized controlled trial.
abstract: OBJECTIVE
  To determine the efficacy of lung volume recruitment maneuver (LVRM) with high frequency oscillatory ventilation (HFOV) on oxygenation, hemodynamic alteration, and clinical outcomes when compared to conventional mechanical ventilation (CV) in children with severe acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  We performed a randomized controlled trial and enrolled pediatric patients who were diagnosed to have severe ARDS upon pediatric intensive care unit (PICU) admission. LVRM protocol combined with HFOV or conventional mechanical ventilation was used. Baseline characteristic data, oxygenation, hemodynamic parameters, and clinical outcomes were recorded.
  
  
  RESULTS
  Eighteen children with severe ARDS were enrolled in our study. The primary cause of ARDS was pneumonia (91.7%). Their mean age was 47.7 ± 61.2 (m) and body weight was 25.3 ± 27.1 (kg). Their initial pediatric risk of mortality score 3 and pediatric logistic organ dysfunction were 12 ± 9.2 and 15.9 ± 12.8, respectively. The initial mean oxygen index was 24.5 ± 10.4, and mean PaO2/FiO2 was 80.6 ± 25. There was no difference in oxygen parameters at baseline the between two groups. There was a significant increase in PaO2/FiO2 (119.2 ± 41.1, 49.6 ± 30.6, P = 0.01*) response after 1 h of LVRM with HFOV compare to CV. Hemodynamic and serious complications were not significantly affected after LVRM. The overall PICU mortality of our severe ARDS at 28 days was 16.7%. Three patients in CV with LVRM group failed to wean oxygen requirement and were cross-over to HFOV group.
  
  
  CONCLUSIONS
  HFOV combined with LVRM in severe pediatric ARDS had superior oxygenation and tended to have better clinical effect over CV. There is no significant effect on hemodynamic parameters. Moreover, no serious complication was noted.
authors.affiliation: Division of Pediatric Critical Care, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Rujipat
authors.initials: R
authors.lastname: Samransamruajkit
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Chavisa
authors.initials: C
authors.lastname: Rassameehirun
authors.affiliation: Division of Pediatric Critical Care, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Khemmachart
authors.initials: K
authors.lastname: Pongsanon
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Sumalee
authors.initials: S
authors.lastname: Huntrakul
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Jitladda
authors.initials: J
authors.lastname: Deerojanawong
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Suchada
authors.initials: S
authors.lastname: Sritippayawan
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Nuanchan
authors.initials: N
authors.lastname: Prapphal
keywords: Conventional ventilation; high frequency oscillatory ventilation; lung volume recruitment maneuver; oxygenation