Related Experiment Video
Updated: Feb 12, 2026
Repeated Measurement of Respiratory Muscle Activity and Ventilation in Mouse Models of Neuromuscular Disease
Published on: April 17, 2017
High frequency oscillatory ventilation in a cohort of children with respiratory failure
Claire A Stewart1, Nadir Yehya2, Lin Fei3
1Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Insights
High frequency oscillatory ventilation (HFOV) in pediatric respiratory failure has a 42% mortality rate. Immunocompromised patients, especially stem cell transplant recipients, face significantly higher mortality. The oxygenation index (OI) at 24 hours best predicts survival.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Transplant Medicine
Background:
- Severe pediatric respiratory failure often necessitates mechanical ventilation.
- High frequency oscillatory ventilation (HFOV) is a specialized ventilatory mode used in critical cases.
- Predicting outcomes in patients on HFOV, particularly those who are immunocompromised, remains a challenge.
Purpose of the Study:
- To determine survival rates for pediatric patients requiring HFOV.
- To identify variables associated with poor outcomes, including immunocompromised status and stem cell transplant (SCT).
- To evaluate oxygenation markers, specifically the oxygenation index (OI), as predictors of outcome before and after HFOV initiation.
Main Methods:
- A retrospective, observational study conducted in two pediatric intensive care units.
- Included 134 pediatric patients treated with HFOV over a 5-year period.
- Calculated oxygenation index (OI) and PF ratios pre-HFOV and at 24 hours post-HFOV initiation.
Main Results:
- Overall mortality was 42%.
- Mortality was significantly higher in immunocompromised (66%) and SCT patients (83%).
- The OI at 24 hours of HFOV was the strongest predictor of mortality, especially in immunocompromised and SCT patients. Survivors received HFOV earlier.
Conclusions:
- HFOV for pediatric respiratory failure is associated with a mortality rate consistent with existing literature.
- Immunocompromised status, particularly SCT, is a significant risk factor for mortality in severe pediatric respiratory failure.
- Early initiation of HFOV and the 24-hour OI are crucial for predicting mortality in this vulnerable population.
Objectives:
Our objective was to determine survival and variables associated with poor outcomes for patients requiring high frequency oscillatory ventilator (HFOV) support. We tested the ability of markers of oxygenation to predict outcome, specifically, the oxygenation index (OI), both prior to and after initiation of HFOV. We also aimed to examine the effect of immunocompromised condition (IC), and specifically stem cell transplant (SCT), on outcome.
Design:
A retrospective, observational study was performed at two pediatric intensive care units (ICU) and included patients treated with HFOV over a 5 year time period. Oxygenation index and PF ratios were calculated for all patients prior to and at 24 h of HFOV support.
Results:
Of the 134 patients meeting inclusion criteria, mortality was 42% with a higher rate of mortality (P < 0.001) for both immunocompromised (66%) and SCT patients (83%). Survivors had improved markers of oxygenation at 24 h as compared to non-survivors (P < 0.001). IC and SCT were the variables most closely associated with mortality. Survivors were placed on HFOV earlier than non-survivors. The OI at 24 h of HFOV support was the best predictor of mortality among markers of oxygenation.
Conclusions:
In this cohort of patients, use of HFOV for pediatric respiratory failure demonstrated a mortality rate in keeping with published data. The presence of an immunocompromised condition was a risk factor for mortality in severe respiratory failure with SCT recipients having the lowest survival rate. The OI at 24 h was the best predictor of mortality, especially in immunocompromised and SCT patients.
Related Concept Videos
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:30Acute Respiratory Failure-III
01:23Acute Respiratory Failure-IV