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High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury: A Multicenter International Experience
Jordan S Rettig1, Craig D Smallwood, Brian K Walsh
11Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2Children's Medical Center of Dallas, Dallas, TX. 3Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland. 4Czech Technical University in Prague, Kladno, Czech Republic. 5Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. 6Pediatric Intensive Care, Queen Paola Children's Hospital, Antwerp, Belgium. 7Division of Pediatric Intensive Care, Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands. 8The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Pediatric patients on high-frequency oscillatory ventilation (HFOV) show varied mortality risks based on diagnosis. Immunocompromise and high oxygenation index predict worse outcomes, while respiratory syncytial virus indicates better survival.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- High-frequency oscillatory ventilation (HFOV) is a critical treatment for pediatric hypoxic respiratory failure.
- Understanding current practices and outcomes is essential for optimizing HFOV use.
- Predictive factors for mortality can guide clinical decision-making.
Purpose of the Study:
- To describe current clinical practice and outcomes of HFOV in pediatric patients.
- To identify factors associated with improved outcomes and mortality risk.
- To develop a model for stratifying mortality risk in pediatric HFOV patients.
Main Methods:
- Multicenter retrospective observational study involving seven Pediatric Intensive Care Units (PICUs).
- Data collected from 328 pediatric patients treated with HFOV between 2009 and 2010.
- Statistical analyses included univariate and multivariate logistic regression to identify mortality predictors.
Main Results:
- Patients were stratified into six diagnostic cohorts.
- Oxygenation index > 35 and immunocompromise were strong predictors of increased mortality risk (p < 0.0001).
- Respiratory syncytial virus infection was associated with the lowest mortality risk (p = 0.003).
Conclusions:
- This study provides a robust description of HFOV practice in pediatric hypoxic respiratory failure.
- Patients with severe disease, immunocompromise face highest mortality; those with RSV have lowest.
- Underlying condition and pre-HFOV oxygenation index can predict 30-day mortality risk.
Objective:
We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillatory ventilation practice.
Design:
Multicenter retrospective, observational questionnaire study.
Setting:
Seven PICUs.
Patients:
Demographic, disease factor, and ventilatory and outcome data were collected, and 328 patients from 2009 to 2010 were included in this analysis.
Interventions:
None.
Measurement And Main Results:
Patients were classified into six cohorts based on underlying diagnosis. We used univariate analysis to identify factors associated with mortality risk and multivariate logistic regression to identify independent predictors of mortality risk. An oxygenation index greater than 35 and immunocompromise exhibited the greatest predictive power (p < 0.0001) for increased mortality risk, and respiratory syncytial virus was associated with lowest mortality risk (p = 0.003). Differences in mortality risk as a function of oxygenation index were highly dependent on primary underlying condition. A trend toward an increase in oscillator amplitude and frequency was observed when compared with historical data.
Conclusions:
Given the number of centers and subjects included in the database, these findings provide a robust description of current practice regarding the use of high-frequency oscillatory ventilation for pediatric hypoxic respiratory failure. Patients with severe hypoxic respiratory failure and immunocompromise had the highest mortality risk, and those with respiratory syncytial virus had the lowest. A means of identifying the risk of 30-day mortality for subjects can be obtained by identifying the underlying disease and oxygenation index on conventional ventilation preceding the initiation of high-frequency oscillatory ventilation.
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