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Published on: April 8, 2022
High-frequency oscillatory ventilation in pediatrics and neonatology
José Roberto Fioretto1, Celso Moura Rebello2
1Departamento de Pediatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista 'Júlio de Mesquita Filho', Botucatu, SP, Brasil.
Insights
High frequency oscillatory ventilation (HFOV) is a key treatment for children with acute respiratory distress syndrome. While beneficial for neonates with air leak syndrome, its superiority over conventional ventilation in neonates is not yet established.
Area of Science:
- Pediatric Pulmonology
- Neonatal Critical Care
- Respiratory Medicine
Background:
- High frequency oscillatory ventilation (HFOV) is an advanced mechanical ventilation strategy.
- Its clinical utility in pediatric and neonatal populations requires comprehensive review.
Purpose of the Study:
- To review the literature on HFOV in children and neonates.
- To describe the main clinical applications and evidence-based outcomes of HFOV.
Main Methods:
- Systematic literature search of MedLine and SciElo databases for articles from the last 15 years.
- Keywords included: high frequency oscillatory ventilation, mechanical ventilation, acute respiratory distress syndrome, children, and neonates.
Main Results:
- HFOV is a viable therapeutic option for children with acute respiratory distress syndrome, air leak syndrome, and obstructive lung disease, recommended for early use.
- In neonates, HFOV shows promise for air leak syndrome but lacks evidence of superiority over conventional mechanical ventilation for conditions like respiratory distress syndrome, bronchopulmonary dysplasia, intracranial hemorrhage, and periventricular leukomalacia.
Conclusions:
- Early HFOV implementation is recommended for children with acute respiratory distress syndrome and may benefit those with air leak syndrome or obstructive pulmonary disease.
- For neonates, HFOV is primarily indicated for air leak syndrome, with further research needed to establish its benefits in other critical respiratory conditions.
Abstract:
This article intends to review literature on high frequency oscillatory ventilation and describe its main clinical applications for children and neonates. Articles from the last 15 years were selected using MedLine and SciElo databases. The following key words were used: high frequency oscillatory ventilation, mechanical ventilation, acute respiratory distress syndrome, children, and new-born. The review describes high frequency oscillatory ventilation in children with acute respiratory distress syndrome, air leak syndrome, and obstructive lung disease. Respiratory distress syndrome, bronchopulmonary dysplasia, intracranial hemorrhage, periventricular leukomalacia, and air leak syndrome were reviewed in neonates. Transition from conventional mechanical ventilation to high frequency ventilation and its adjustments relating to oxygenation, CO2 elimination, chest radiography, suctioning, sedatives and use of neuromuscular blocking agents were described. Weaning and complications were also reported. For children, high frequency oscillatory ventilation is a therapeutic option, particularly in acute respiratory distress syndrome, and should be used as early as possible. It may be also useful in the air leak syndrome and obstructive pulmonary disease. Evidence that, in neonates, high frequency oscillatory ventilation is superior to conventional mechanical ventilation is lacking. However there is evidence that better results are only achieved with this ventilatory mode to manage the air leak syndrome.
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