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High-frequency percussive ventilation and bronchoscopy during extracorporeal life support in children

Nadir Yehya1, Cheryl L Dominick, James T Connelly

  • 1From the *Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; †Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ‡ECMO Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and §Department of Surgery, Nationwide Children's Hospital, Center for Surgical Outcomes Research, Columbus, Ohio.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 17, 2014
PubMed

Insights

High frequency percussive ventilation (HFPV) combined with bronchoscopies may shorten pediatric extracorporeal life support (ECLS) duration. This strategy was associated with more days alive and off ECLS, suggesting improved patient outcomes.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Prolonged extracorporeal life support (ECLS) in children is linked to increased mortality.
  • Lung recruitment and secretion clearance strategies may reduce ECLS duration.
  • High frequency percussive ventilation (HFPV) aids secretion clearance, particularly in inhalational injury.

Purpose of the Study:

  • To describe the application of HFPV and therapeutic bronchoscopies in pediatric ECLS.
  • To evaluate the impact of HFPV on ECLS duration and patient outcomes.
  • To compare outcomes between a cohort using HFPV and a historical control group.

Main Methods:

  • Retrospective analysis of pediatric ECLS patients (n=36) from a single center.
  • Comparison of a cohort managed with HFPV during ECLS (n=14) to a pre-HFPV control group (n=22).
  • Assessment of ECLS-free days at 30 and 60 days, and bronchoscopy utilization.

Main Results:

  • The HFPV cohort underwent more bronchoscopies than the pre-HFPV cohort.
  • Univariate and multivariate analyses showed HFPV use was associated with increased ECLS-free days.
  • No significant demographic differences or differences in venoarterial ECLS utilization between cohorts.

Conclusions:

  • HFPV and bronchoscopies during pediatric ECLS for respiratory failure are associated with more ECLS-free days.
  • This strategy may improve outcomes by facilitating lung recruitment and secretion clearance.
  • Prospective evaluation of HFPV during pediatric ECLS is warranted.

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