Factors associated with high-frequency oscillatory ventilation response in infants with respiratory failure

A prospective, clinical study was conducted to investigate the factors associated with the effectiveness and outcome of high-frequency oscillatory ventilation (HFOV) in infants with respiratory failure unresponsive to optimal conventional respiratory and pharmacological therapy. A high-lung volume strategy was used in cases with diffuse lung disease. A total of 30 treatments in 24 patients (including 14 premature infants), aged 1 to 127 days, was included for analysis. By 6 to 8 hours, > 20% improvement in oxygenation (good response) was noted in 57% of treatments. < 20% improvement (poor response) in 20%, 23% showed delayed response 10 to 24 hours after initiation of HFOV. Thirty-five percent of treatments with initial good response deteriorated later because of severe underlying problems or occurrence of ventilatory complications. Seventeen treatments (57%) were weaned successfully to conventional mechanical ventilation (CMV). Poor response was associated with a higher oxygenation index prior to HFOV and a severe underlying problem. Failure to be successfully weaned to CMV was associated with a higher mean airway pressure and a severe underlying condition. Premature infants and infants with the persistent pulmonary hypertension of newborn usually had a good response to HFOV. From results of this study, it is concluded that patients with severe lung disease and a severe underlying problem responded poorly to HFOV. An initial good response did not predict successful weaning.