Continuous High-Frequency Oscillation Therapy in Invasively Ventilated Pediatric Subjects in the Critical Care
Stephen Morgan1, Christoph P Hornik2,3, Niyati Patel4
1Respiratory Care Services, Duke University Hospital, Duke University Medical Center, Durham, North Carolina.
Insights
Continuous high-frequency oscillation (CHFO) is a feasible and safe therapy for mechanically ventilated children, potentially improving lung compliance. Further studies are needed to confirm its clinical efficacy and safety in this population.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Mechanical ventilation
Background:
- Continuous high-frequency oscillation (CHFO) generates a pressure gradient to enhance expiratory flow.
- CHFO therapy aims to aid secretion removal and treat atelectasis.
- Assessing CHFO feasibility, safety, and efficacy in pediatric mechanical ventilation is crucial.
Purpose of the Study:
- To evaluate the feasibility and safety of CHFO in mechanically ventilated children.
- To assess the efficacy of CHFO in improving respiratory parameters.
- To determine the incidence of adverse events associated with CHFO in this population.
Main Methods:
- Retrospective review of medical records for pediatric patients receiving CHFO (MetaNeb system).
- Analysis of ventilator settings and arterial blood gas (ABG) results pre- and post-CHFO treatment.
- Exclusion of patients on extracorporeal membrane oxygenation; comparison using Wilcoxon signed-rank testing.
Main Results:
- 59 pediatric subjects received 528 CHFO treatments; median age 2 years.
- Peak inspiratory pressure decreased significantly; PaCO2 and breathing frequency remained stable.
- No significant changes in blood pressure or heart rate; one instance of pneumothorax (2%).
Conclusions:
- CHFO is feasible and appears safe in mechanically ventilated pediatric subjects.
- The observed pneumothorax rate is comparable to similar pediatric ICU populations.
- Preliminary findings suggest CHFO may improve lung compliance, warranting further investigation.
Background:
Continuous high-frequency oscillation (CHFO) creates a pressure gradient in the small airways that accelerates expiratory flow. The intended use of CHFO therapy is to facilitate secretion removal and treat atelectasis. Our objective was to assess the feasibility, safety, and efficacy of CHFO in the mechanically ventilated pediatric population.
Methods:
After institutional review board approval, we retrospectively reviewed medical records of mechanically ventilated children treated with CHFO (the MetaNeb system) at our institution from July 1, 2007 through August 31, 2012. Patients supported with extracorporeal membrane oxygenation were excluded. We evaluated changes in ventilator settings in subjects with ventilator data documented within 6 h pre- and post-treatment. We evaluated arterial blood gas (ABG) results for individual treatments, comparing ABG results within 8 h pre-therapy to ABG results within 3 h post-treatment. Oxygen index and PaO /FIO were calculated. Demographic data, blood pressure, heart rate, and development of new air leak while being treated with CHFO were recorded. Pre- and post-CHFO measurements were compared using Wilcoxon signed-rank testing.
Results:
Our cohort included 59 invasively ventilated subjects. Median age was 2 y (range 1 month to 19 y), and median weight was 14 kg (2-81 kg). We evaluated data on 528 total treatments (range per subject 1-39 treatments). Peak inspiratory pressure significantly decreased with CHFO, whereas other parameters, including PaCO and breathing frequency, remained stable. There was no significant change in systolic blood pressure, diastolic blood pressure, or heart rate following treatment with CHFO. One subject (2%) developed a clinically insignificant pneumothorax during CHFO.
Conclusions:
CHFO is feasible and seems safe in our cohort of mechanically ventilated pediatric subjects. The rate of pneumothorax was consistent with that seen in similar pediatric ICU populations. These preliminary results suggest that CHFO may be beneficial by improving lung compliance in pediatric subjects with secretion-induced atelectasis. Prospective clinical studies are needed to further evaluate the clinical efficacy and safety of CHFO in children receiving invasive mechanical ventilation.
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