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Outcomes of Severe PARDS on High-Frequency Oscillatory Ventilation - A Single Centre Experience

Arpita Chattopadhyay1, Samriti Gupta1, Jhuma Sankar1

  • 1Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Indian Journal of Pediatrics
|January 12, 2020
PubMed

Insights

High-frequency oscillatory ventilation (HFOV) can improve survival in pediatric acute respiratory distress syndrome (PARDS) when initiated promptly. Early HFOV and a rapid decline in the Oxygenation Index predict better outcomes for children with severe respiratory failure.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Pediatric acute respiratory distress syndrome (PARDS) poses significant management challenges, often requiring advanced ventilatory support.
  • Conventional mechanical ventilation (CMV) may be insufficient for severe cases, necessitating alternative strategies like high-frequency oscillatory ventilation (HFOV).

Purpose of the Study:

  • To evaluate the use of HFOV in children with PARDS who were transitioned from CMV due to persistent hypoxemia.
  • To identify factors associated with survival in these patients.
  • To compare outcomes between early (within 24 hours of intubation) and late HFOV initiation.

Main Methods:

  • Retrospective observational study in a pediatric intensive care unit.
  • Inclusion of 34 children with PARDS managed with HFOV after failure of CMV.
  • Analysis of survival predictors, including Oxygenation Index (OI) and PaO2/FiO2 (P/F) ratio trends.

Main Results:

  • Eight out of 34 children with PARDS survived.
  • Improvement in OI at 48 hours and P/F ratio at 24 hours predicted survival.
  • Lower Positive End-Expiratory Pressure (PEEP) on CMV and shorter CMV duration before HFOV were associated with survival.
  • OI trends between 24 and 48 hours differentiated survivors from non-survivors.

Conclusions:

  • Survival in pediatric ARDS patients treated with HFOV can be predicted by OI trends.
  • Survivors demonstrate a more rapid decline in OI between 24 and 48 hours of HFOV initiation compared to non-survivors.
Abstract

Keywords:
Conventional mechanical ventilationHigh-frequency oscillatory ventilationPediatric ARDS

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