High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis

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Michel E Berner1, Sylviane Hanquinet, Peter C Rimensberger

  • 1Neonatology and Paediatric Intensive Care Service, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. michel.berner@hcuge.ch

Intensive Care Medicine
|May 27, 2008
PubMed

Insights

High frequency oscillatory ventilation (HFOV) effectively manages respiratory syncytial virus (RSV) bronchiolitis in infants. This method utilizes high airway pressure and pressure swings, allowing for spontaneous breathing during recovery.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Infectious Diseases

Background:

  • Respiratory syncytial virus (RSV) bronchiolitis is a common cause of respiratory failure in infants.
  • Conventional mechanical ventilation (CMV) may be insufficient for severe cases.
  • High frequency oscillatory ventilation (HFOV) is an alternative ventilatory strategy.

Purpose of the Study:

  • To describe the time course and effects of HFOV in infants with RSV-induced respiratory failure.
  • To analyze ventilatory settings, blood gases, and clinical parameters during HFOV treatment.

Main Methods:

  • Retrospective chart review of infants with RSV bronchiolitis requiring mechanical ventilation.
  • Comparison of ventilatory parameters during conventional mechanical ventilation (CMV), early, mid, and late HFOV, and post-extubation.
  • Analysis of blood gases, vital signs, and sedation/analgesia use.

Main Results:

  • Infants exhibited an overexpanded lung pattern on HFOV.
  • Mean airway pressure increased initially with HFOV then decreased, while FiO2 and peak-to-peak pressure were reduced.
  • PaCO2 showed a decreasing trend, and respiratory rate increased, indicating improved ventilation.
  • Infants were extubated after a mean of 120 hours without paralysis.

Conclusions:

  • HFOV is a viable treatment for RSV-induced respiratory failure with hypercapnia.
  • The strategy involves high mean airway pressure and significant pressure swings.
  • HFOV facilitates spontaneous breathing during recovery in these critically ill infants.
Abstract

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