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Published on: January 17, 2011
High-frequency oscillatory ventilation in pediatric respiratory failure: a multicenter experience
J H Arnold1, N G Anas, P Luckett
1Department of Anesthesia, Children's Hospital, Boston, MA 02115, USA.
Insights
High-frequency oscillatory ventilation (HFOV) is increasingly used for pediatric respiratory failure. This study identifies patient factors influencing HFOV outcomes, aiding in risk stratification and guiding future research.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- High-frequency oscillatory ventilation (HFOV) use has surged for pediatric respiratory failure.
- Understanding factors influencing HFOV effectiveness is crucial for optimizing patient care.
- Current clinical practices and outcomes associated with HFOV require detailed examination.
Purpose of the Study:
- To describe current clinical practices in HFOV management across pediatric centers.
- To identify factors associated with improved outcomes in pediatric patients receiving HFOV.
- To stratify risk and identify high-risk populations for further investigation.
Main Methods:
- Retrospective, observational questionnaire study involving ten tertiary care pediatric intensive care units.
- Analysis of 290 pediatric patients managed with HFOV between January 1997 and June 1998.
- Classification of patients based on preexisting lung disease, viral infections, and cardiac conditions.
Main Results:
- Patients with preexisting lung disease had smaller size, higher infection incidence, and longer prior ventilation duration.
- Logistic regression models predicted mortality and chronic lung disease based on oxygenation index (OI) at 24 hours.
- Specific OI thresholds predicted high probabilities of death or chronic lung disease in various patient subgroups.
Conclusions:
- Study findings reflect current pediatric HFOV practices and highlight key outcome predictors.
- Results can inform decisions regarding extracorporeal support and identify candidates for advanced interventions.
- Identified high-risk populations are suitable for prospective studies on novel gas exchange support methods.
Objective:
The use of high-frequency oscillatory ventilation (HFOV) has increased dramatically in the management of respiratory failure in pediatric patients. We surveyed ten pediatric centers that frequently use high-frequency oscillation to describe current clinical practice and to examine factors related to improved outcomes.
Design:
Retrospective, observational questionnaire study.
Setting:
Ten tertiary care pediatric intensive care units.
Patients:
Two hundred ninety patients managed with HFOV between January 1997 and June 1998.
Interventions:
None.
Measurements And Main Results:
Patients were classified according to presence or absence of preexisting lung disease, symptomatic respiratory syncytial virus infection, or presence of cyanotic heart disease or residual right-to-left intracardiac shunt. In addition, patients for whom HFOV acutely failed were analyzed separately. Those patients with preexisting lung disease were significantly smaller, had a significantly higher incidence of pulmonary infection as the triggering etiology, and had a significantly greater duration of conventional ventilation before institution of HFOV compared with patients without preexisting lung disease. Stepwise logistic regression was used to predict mortality and the occurrence of chronic lung disease in survivors. In patients without preexisting lung disease, the model predicted a 70% probability of death when the oxygenation index (OI) after 24 hrs was 28 in the immunocompromised patients and 64 in the patients without immunocompromise. In the immunocompromised patients, the model predicted a 90% probability of death when the OI after 24 hrs was 58. In survivors without preexisting lung disease, the model predicted a 70% probability of developing chronic lung disease when the OI at 24 hrs was 31 in the patients with sepsis syndrome and 50 in the patients without sepsis syndrome. In the patients with sepsis syndrome, the model predicted a 90% probability of developing chronic lung disease when the OI at 24 hrs was 45.
Conclusions:
Given the number of centers involved and the size of the database, we feel that our results broadly reflect current practice in the use of HFOV in pediatric patients. These results may help in deciding which patients are most likely to benefit from aggressive intervention by using extracorporeal techniques and may help identify high-risk populations appropriate for prospective study of innovative modes of supporting gas exchange (e.g., partial liquid breathing or intratracheal pulmonary ventilation).
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