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Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults
Published on: February 9, 2022
[High-frequency oscillatory ventilation in pediatric patients. protocol and preliminary results]
F Martinón Torres1, A Rodríguez Núñez, D G Jaimovich
1Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela. fedemartinon@hotmail.com
Insights
High-frequency oscillatory ventilation (HFOV) is a safe and effective treatment for pediatric respiratory failure when conventional methods fail. Early HFOV initiation in critically ill children with refractory respiratory failure can improve outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- High-frequency oscillatory ventilation (HFOV) offers advantages over conventional ventilation, including reduced lung injury.
- Pediatric applications of HFOV extend beyond neonatal use.
- Limited prior experience with HFOV in pediatric patients in the region.
Purpose of the Study:
- To establish and describe a protocol for HFOV in pediatric patients.
- To report preliminary outcomes of a prospective HFOV application in children.
Main Methods:
- Developed an HFOV protocol with specific inclusion criteria for severe respiratory insufficiency and airleak syndromes.
- Included patients with refractory ARDS and severe RSV pneumonia.
- Analyzed ventilatory, gasometric, and hemodynamic parameters for the first 24 hours.
Main Results:
- Six pediatric patients (3 days to 8 years) with severe refractory ARDS received HFOV.
- Mean oxygenation index (OI) significantly improved from 45.9 to 23.9 within 1 hour.
- Normal gas exchange was achieved with reduced fraction of inspired oxygen (FiO2) within 3 hours; no HFOV-related complications.
Conclusions:
- HFOV is a safe and effective alternative for pediatric patients with refractory respiratory failure.
- Early initiation of HFOV is crucial for better patient outcomes.
- Referral to specialized centers for HFOV is recommended for children with severe respiratory failure.
Background:
High-frequency oscillatory ventilation (HFOV) constitutes an important advance in the management of children with respiratory failure. Although it has been used mainly as "lung rescue therapy", pediatric indications for HFOV can be broader. The principal advantages of this modality compared with conventional ventilation are the lower incidence of barotrauma, volutrauma, atelectrauma and biotrauma. To date, experience with HFOV in our country has been scarce and limited to neonatal patients.
Aim:
To describe the HFOV protocol for pediatric patients and to report the preliminary results of its prospective application.
Materials And Methods:
An HFOV protocol was established with the following inclusion criteria: severe respiratory insufficiency of any origin (infectious, inhalatory, etc.) with an oxygenation index (OI) > 13 in two arterial blood gases within a 6-hour interval, refractory acute respiratory distress syndrome (ARDS), severe respiratory syncytial virus pneumonia, and gross airleak syndromes (pneumothorax, pneumoperitoneum, pneumomediastinum, etc.). Conventional and HFOV ventilatory, gasometric and hemodynamic parameters of patients included in the protocol during a 5-month period were registered, and the first 24 hours were analyzed.
Results:
Six patients aged between 3 days and 8 years, weighing between 4 and 80 kg met the inclusion criteria. In all patients HVOF was indicated due to severe refractory ARDS. The pre-HFOV mean OI was 45.9. After 1 hour of HFOV mean OI decreased to 23.9 and continued to improve during the first 24 hours. In all patients, normal arterial PO2 and PCO2 were obtained and FiO2 could be set below 0.6 within the first 3 hours of HFOV. No complications associated with HFOV were detected. Outcome was satisfactory in two patients while four patients died secondary to multiorgan failure.
Conclusions:
HFOV is a safe and effective ventilatory modality in critically ill pediatric patients in whom conventional ventilation is not effective. To obtain better results, HFOV should be started early. Every child with refractory respiratory failure should be referred early to centers where HFOV can be offered.
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