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[High frequency oscillatory ventilation of infants with severe respiratory disorders: possibilities, risks and
V Varnholt1, P Lasch, W Kachel
1Kinderklinik und Institut für klinische Radiologie, Universitätsklinikum Mannheim.
Insights
High-frequency oscillatory ventilation (HFOV) effectively treated severe pneumonia and air leaks in infants when conventional methods failed. This rescue therapy enabled successful weaning to standard support, demonstrating HFOV
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Neonatalogy
Background:
- High-frequency oscillatory ventilation (HFOV) is primarily utilized in neonatal intensive care.
- Conventional ventilatory support often proves insufficient for severe pulmonary insufficiency in infants.
- Limited data exists on HFOV application in non-neonatal infants with refractory respiratory failure.
Purpose of the Study:
- To evaluate the efficacy and safety of HFOV as a rescue therapy in infants with severe pulmonary insufficiency.
- To assess HFOV's impact on oxygenation, air leaks, and the ability to transition back to conventional ventilation.
Main Methods:
- Retrospective analysis of 6 infants (2-7 months) with severe pneumonia and respiratory failure.
- Patients received HFOV after failure of conventional ventilatory support.
- Indications included severe hypoxia and/or air leak syndrome.
Main Results:
- HFOV achieved sufficient oxygenation in all infants, allowing for stepwise reduction in ventilator settings.
- Air leak syndromes resolved in all treated infants.
- Successful transition to conventional ventilation was possible within 12-178 hours, with extubation occurring 6-15 days later.
Conclusions:
- HFOV serves as an effective rescue therapy for severe pulmonary insufficiency in infants beyond the neonatal period.
- Potential risks include air leaks, tracheobronchitis, and hemodynamic compromise.
- Current HFOV devices in Germany may necessitate limiting use to infants under 5-6 kg.
Abstract:
By pediatricians the high frequency oscillatory ventilation (HFOV) is used almost only in the neonatal period. We report on the administration of HFOV in infants with pulmonary insufficiency after failure of conventional ventilatory support. 6 infants (aged 2-7 months, all former preterm babies) were referred to our hospital due to severe pneumonia after unsuccessful conservative management. Indications for HFOV were hypoxia (mean paO2 41.8 mm Hg with FiO2 = 0.95 and mean airway pressure = 16.6 cm H2O) and/or air leak syndrome. In all cases a sufficient oxygenation could be achieved by HFOV, followed then by stepwise reduction of FiO2 and MAP. The air leaks receded. After 12-178 h on HFOV a successful switchback to conventional ventilatory support (at FiO2 = 0.48 and MAP < 12 cm H2O) was possible, all infants were extubated 6-15 days later. Possible risks of HFOV are air leaks, a necrotizing tracheobronchitis and hemodynamic changes due to compression of the heart and great vessels. With the at the moment in Germany available oscillatory ventilators HFOV as a rescue therapy must be limited for infants with a body weight below 5-6 kg.