[Effects of high frequency oscillatory ventilation on gas exchanges in pediatric patients with acute respiratory failure]

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 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]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 [pcomplications 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