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High-frequency oscillatory ventilation and short-term outcome in neonates and infants undergoing cardiac surgery: a

Mirela Bojan1, Simone Gioanni, Philippe Mauriat

  • 1Anesthesiolgy and Critical Care Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France. mirela.bojan@nck.aphp.fr

Critical Care (London, England)
|November 1, 2011
PubMed

Insights

High-frequency oscillatory ventilation (HFOV) initiated on the day of surgery in neonates and infants with respiratory distress after cardiac surgery was associated with shorter mechanical ventilation and ICU stays compared to conventional mechanical ventilation (CMV).

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiothoracic Surgery
  • Neonatal Respiratory Support

Background:

  • Limited data exists on high-frequency oscillatory ventilation (HFOV) use post-congenital cardiac surgery.
  • HFOV is recommended for acute respiratory distress syndrome in pediatric populations.
  • Early HFOV may reduce pulmonary vascular resistance, particularly after the Fontan procedure.

Purpose of the Study:

  • To evaluate the association between initiating HFOV on the day of surgery and patient outcomes.
  • To compare the length of mechanical ventilation, ICU stay, and mortality in neonates and infants receiving HFOV versus conventional mechanical ventilation (CMV).

Main Methods:

  • A propensity score-matched analysis was conducted using data from 3,549 neonates and infants undergoing cardiac surgery.
  • Patients switched to HFOV on the day of surgery (n=120) were matched with controls receiving exclusive CMV (n=120).
  • Logistic regression adjusted for clinical variables including delay to sternal closure, renal replacement therapy, and pulmonary hypertension.

Main Results:

  • HFOV initiation on the day of surgery was significantly associated with a higher probability of successful weaning (aHR 1.63, P=0.004) and ICU discharge (aHR 1.65, P=0.002).
  • No significant association was found between early HFOV and mortality rates.
  • The study included 120 HFOV patients and 120 matched CMV controls.

Conclusions:

  • Commencing HFOV on the day of surgery in neonates and infants with respiratory distress post-cardiac surgery is linked to reduced mechanical ventilation duration.
  • Early HFOV use was associated with shorter Intensive Care Unit (ICU) stays compared to CMV.
  • HFOV demonstrates a potential benefit in managing respiratory distress following pediatric cardiac procedures.
Abstract

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