title: Continuous High-Frequency Oscillation Therapy in Invasively Ventilated Pediatric Subjects in the Critical Care Setting.
abstract: BACKGROUND
  Continuous high-frequency oscillation (CHFO) creates a pressure gradient in the small airways that accelerates expiratory flow. The intended use of CHFO therapy is to facilitate secretion removal and treat atelectasis. Our objective was to assess the feasibility, safety, and efficacy of CHFO in the mechanically ventilated pediatric population.
  
  
  METHODS
  After institutional review board approval, we retrospectively reviewed medical records of mechanically ventilated children treated with CHFO (the MetaNeb system) at our institution from July 1, 2007 through August 31, 2012. Patients supported with extracorporeal membrane oxygenation were excluded. We evaluated changes in ventilator settings in subjects with ventilator data documented within 6 h pre- and post-treatment. We evaluated arterial blood gas (ABG) results for individual treatments, comparing ABG results within 8 h pre-therapy to ABG results within 3 h post-treatment. Oxygen index and PaO2/FIO2were calculated. Demographic data, blood pressure, heart rate, and development of new air leak while being treated with CHFO were recorded. Pre- and post-CHFO measurements were compared using Wilcoxon signed-rank testing.
  
  
  RESULTS
  Our cohort included 59 invasively ventilated subjects. Median age was 2 y (range 1 month to 19 y), and median weight was 14 kg (2-81 kg). We evaluated data on 528 total treatments (range per subject 1-39 treatments). Peak inspiratory pressure significantly decreased with CHFO, whereas other parameters, including PaCO2and breathing frequency, remained stable. There was no significant change in systolic blood pressure, diastolic blood pressure, or heart rate following treatment with CHFO. One subject (2%) developed a clinically insignificant pneumothorax during CHFO.
  
  
  CONCLUSIONS
  CHFO is feasible and seems safe in our cohort of mechanically ventilated pediatric subjects. The rate of pneumothorax was consistent with that seen in similar pediatric ICU populations. These preliminary results suggest that CHFO may be beneficial by improving lung compliance in pediatric subjects with secretion-induced atelectasis. Prospective clinical studies are needed to further evaluate the clinical efficacy and safety of CHFO in children receiving invasive mechanical ventilation.
authors.affiliation: Respiratory Care Services, Duke University Hospital, Duke University Medical Center, Durham, North Carolina.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morgan
authors.affiliation: Division of Pediatric Critical Care Medicine.|Division of Quantitative Sciences, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Niyati
authors.initials: N
authors.lastname: Patel
authors.affiliation: Respiratory Care Services, Children's Hospital of the King's Daughters, Norfolk, Virginia.
authors.forename: Walter L
authors.initials: WL
authors.lastname: Williford
authors.affiliation: Division of Pediatric Critical Care Medicine.
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
authors.affiliation: Respiratory Care Services, Duke University Hospital, Duke University Medical Center, Durham, North Carolina. ira.cheifetz@duke.edu.|Division of Pediatric Critical Care Medicine.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Cheifetz
mesh_terms: D000293:Adolescent; D001784:Blood Gas Analysis; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000072277:Maximal Respiratory Pressures; D011030:Pneumothorax / Q000209:etiology; D001261:Pulmonary Atelectasis / Q000097:blood / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: airway clearance; atelectasis; gas exchange; intrapulmonary percussive ventilation; mechanical ventilation; mucociliary clearance; pediatric