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Skin breakdown in children and high-frequency oscillatory ventilation
J E Schmidt1, R J Berens, M B Zollo
1Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, USA.
Archives of Physical Medicine and Rehabilitation
|December 23, 1998
Summary
High-frequency oscillatory ventilation (HFOV) did not cause skin breakdown in children. Prolonged time in the pediatric intensive care unit (PICU) was the only identified risk factor for skin breakdown in mechanically ventilated patients.
Area of Science:
- Pediatric critical care medicine
- Mechanical ventilation
- Patient safety
Background:
- Skin breakdown is a concern in pediatric intensive care units (PICUs).
- High-frequency oscillatory ventilation (HFOV) is a mode of mechanical ventilation used in critically ill children.
- The association between HFOV and skin breakdown requires further investigation.
Purpose of the Study:
- To determine if high-frequency oscillatory ventilation (HFOV) is an independent risk factor for skin breakdown.
- To identify risk factors for skin breakdown in mechanically ventilated children.
Main Methods:
- Retrospective cohort study comparing 32 patients on HFOV with 32 patients on conventional ventilation (CV).
- Data collected from a pediatric intensive care unit (PICU).
- Analysis included univariate, life table, and multifactorial assessments.
Main Results:
- Univariate analysis showed a higher incidence of skin breakdown in HFOV patients (53%) compared to CV patients (12.5%).
- HFOV patients had higher severity of illness, mortality, and longer durations of neuromuscular blockade, low blood pressure, and exposure to risk.
- Life table and multifactorial analyses revealed no significant difference in skin breakdown rates between HFOV and CV groups.
- PICU time at risk was identified as the sole independent risk factor for skin breakdown.
Conclusions:
- High-frequency oscillatory ventilation (HFOV) is not an independent risk factor for skin breakdown.
- Prolonged time in the PICU is the primary risk factor for skin breakdown in mechanically ventilated children.
- These findings emphasize the importance of managing exposure time in the PICU to prevent skin breakdown.
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