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Use of High-Frequency Ventilation in the Pediatric Intensive Care Unit

Daniel S Tawfik1, Tellen D Bennett2,3, Brent Welch4

  • 1Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States.

Journal of Pediatric Intensive Care
|May 22, 2019
PubMed

Insights

High-frequency percussive ventilation (HFPV) rapidly improved oxygenation and ventilation in pediatric acute respiratory failure patients. HFPV showed lower mortality compared to high-frequency oscillatory ventilation (HFOV), suggesting its benefit in managing respiratory distress.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Acute respiratory failure is a critical condition in children requiring advanced ventilatory support.
  • High-frequency ventilation (HFV) encompasses various modes, including high-frequency percussive ventilation (HFPV) and high-frequency oscillatory ventilation (HFOV).
  • Comparative data on HFPV and HFOV in pediatric acute respiratory failure are limited.

Purpose of the Study:

  • To compare the clinical characteristics, ventilator settings, and gas exchange of pediatric patients managed with HFPV versus HFOV.
  • To evaluate the effectiveness and outcomes associated with HFPV and HFOV in children with acute respiratory failure.

Main Methods:

  • Retrospective observational study of pediatric patients (0-18 years) with acute respiratory failure.
  • Data collected from May 2012 to July 2013, comparing patients initially managed with HFPV versus HFOV.
  • Analysis of clinical characteristics, ventilator parameters, gas exchange indices (SF ratio, PaCO2), airway pressures, and mortality.

Main Results:

  • HFPV was more frequently used in patients with less severe illness (lower PIM2 scores, higher SF ratios).
  • HFPV demonstrated rapid improvements in oxygenation (SF ratio) and ventilation (PaCO2) within 6 hours, unlike HFOV.
  • Peak inspiratory and mean airway pressures remained within acceptable limits (<30 cm H2O) for both modes. Mortality was significantly lower with HFPV (15%) compared to HFOV (50%).

Conclusions:

  • HFPV facilitates prompt improvement in oxygenation and ventilation at safe airway pressures for pediatric acute respiratory failure.
  • HFPV is particularly beneficial for patients with ventilation or secretion management challenges.
  • HFOV appears to be reserved for more critically ill children in this institution, while HFPV offers a potentially more effective initial approach.

Keywords:
acute lung injuryacute respiratory failurehigh-frequency oscillatory ventilationhigh-frequency percussive ventilationhigh-frequency ventilation

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