ABSTRACT
There is increasing use of high frequency oscillatory ventilation [HFOV] in [rescuing] pediatric patients with acute respiratory failure [ARF], failing conventional ventilation [CV]. Because HFOV is considered to be a [rescue] therapy, intervention with HFOV is usually in the later stages of respiratory failure, after a prolonged CV. The objective of this study was to evaluate the effectiveness of HFOV, used as [early rescue] therapy, on gas exchanges in pediatric patients with ARF and diffuse alveolar disease. An HFOV protocol for pediatric patients with ARF was established with the following entry criteria: body weight of = 35 kg, ARF with diffuse alveolar disease, failing CV with lung protective strategy, as defined by FiO[2] requirements more than 0,6 for 4 hours to maintain SaO[2] >/= 90% and PaO[2]/= 65 torr [8.6kPa]. Ventilaor settings, arterial blood gases, Oxygenation index [OI], alveolar-arterial oxygen difference [P[A-a]O2] and PaO[2]/FiO[2] ratio were prospectively recorded prior to HFOV [0h] and at predetermined intervals throughout the course of the HFOV protocol. Twenty patients [mean age: 10.7 +/- 17 months] were enrolled in the study protocol after a mean length of CV of 24.7 +/- 13 hours. Mean OI at 0h was 26 +/-8. Initiation of HFOV caused a decrease in mean FiO[2] at 1 hour that continued to 24 hours [p/=0.04]. After one hour, mean PaCO[2] decreased from 70.7 +/- 41 to 41.5 +/- 10 mmHg [p=0.002] and remained within the target range. There was a decrease in mean P[A-a] O[2] and OI at 1 and 4 hours, respectively, [p=0.001] and an increase in PaO[2]/FiO[2] ratio at 1 hours [p=0.003] that were sustained up to 12 hours [p/- 0.04]. No significant complications associated with HFOV were detected. Sixteen patients [80%] met weaning criteria and 15 patients [75%] survived to hospital discharge. Only one patient died from respiratory failure. In pediatric patients with ARF, HFOV, used as [early rescue] therapy, improves gas exchange in a rapid and sustained fashion. However, randomized controlled trials are needed to establish the optimum timing of HFOV initation