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Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation
J H Arnold1, J H Hanson, L O Toro-Figuero
1Department of Anesthesia, Children's Hospital, Boston, MA 02115.
Insights
High-frequency oscillatory ventilation improved oxygenation in pediatric respiratory failure patients. This method, using lung volume recruitment, showed fewer instances of barotrauma compared to conventional ventilation.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Mechanical ventilation strategies
Background:
- Pediatric respiratory failure necessitates mechanical ventilation.
- Conventional mechanical ventilation (CMV) carries risks like barotrauma.
- High-frequency oscillatory ventilation (HFOV) offers an alternative approach.
Purpose of the Study:
- To compare the efficacy of HFOV versus CMV in pediatric patients with respiratory failure.
- To evaluate oxygenation, airleak, and survival outcomes between HFOV and CMV.
Main Methods:
- A prospective, randomized, crossover clinical study was conducted in five pediatric intensive care units.
- Seventy pediatric patients with diffuse alveolar disease and/or airleak syndrome were randomized to HFOV or CMV.
- Specific ventilatory strategies were employed for each group, with crossover permitted upon treatment failure.
Main Results:
- HFOV significantly improved the PaO2/PAO2 ratio and decreased the oxygenation index over time.
- No significant differences were observed in the duration of mechanical ventilation, airleak frequency, or 30-day survival rates between groups.
- Fewer patients in the HFOV group required supplemental oxygen at 30 days, indicating reduced barotrauma.
Conclusions:
- HFOV, employing an aggressive volume recruitment strategy, enhances oxygenation in pediatric respiratory failure.
- The optimal lung volume strategy with HFOV was associated with a lower frequency of barotrauma and improved outcomes compared to CMV.
- HFOV represents a potentially safer and more effective ventilation strategy for pediatric respiratory failure.
Objective:
To compare the effectiveness of high-frequency oscillatory ventilation with conventional mechanical ventilation in pediatric patients with respiratory failure.
Setting:
Five tertiary care pediatric intensive care units.
Design:
A prospective, randomized, clinical study with crossover.
Patients:
Seventy patients with either diffuse alveolar disease and/or airleak syndrome were randomized to receive high-frequency oscillatory ventilation or conventional mechanical ventilation.
Interventions:
Patients randomized to receive high-frequency oscillatory ventilation were managed, using a strategy that consisted of aggressive increases in mean airway pressure to attain the "ideal" lung volume and to achieve an arterial oxygen saturation of > or = 90%, with an FIO2 of < or = 0.6. Patients who were randomized to receive conventional mechanical ventilation were treated with a strategy that utilized increases in end-expiratory pressure and inspiratory time to increase mean airway pressure and to limit increases in peak inspiratory pressure. Target blood gas values were the same for both groups. Crossover to the alternate ventilator was required if the patient met defined criteria for treatment failure.
Measurements And Main Results:
Physiologic data and ventilatory parameters were collected prospectively at predetermined intervals after randomization. Airleak Scores were derived daily, based on the chest radiograph and the patient's clinical condition. In the high-frequency oscillatory ventilation group, the PaO2/PAO2 ratio increased significantly and the oxygenation index (mean airway pressure x FIO2 x 100/PaO2) decreased significantly over time. There were no differences between the groups in duration of mechanical ventilation, frequency of airleak, Airleak Scores, or 30-day survival rates. Significantly fewer patients treated with high-frequency oscillatory ventilation required supplemental oxygenation at 30 days compared with patients managed with conventional ventilation. When ventilatory subgroups were compared, the patients managed with high-frequency oscillation only had significantly better ranked outcomes than patients managed with conventional ventilation only.
Conclusions:
Our results indicate that high-frequency oscillatory ventilation, utilizing an aggressive volume recruitment strategy, results in significant improvement in oxygenation compared with a conventional ventilatory strategy designed to limit increases in peak airway pressures. Furthermore, despite the use of higher mean airway pressures, the optimal lung volume strategy used in this study was associated with a lower frequency of barotrauma, as indicated by requirement for supplemental oxygen at 30 days, and improved outcome compared with conventional mechanical ventilation.