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High-frequency oscillatory ventilation in paediatric patients with acute respiratory distress syndrome—early rescue use

Abstract

In order to determine the response to high-frequency oscillatory ventilation (HFOV), used as an “early rescue” therapy, in a cohort of paediatric patients with acute respiratory distress syndrome (ARDS), a prospective clinical study was performed in a tertiary care paediatric intensive care unit. Ten consecutive patients, aged 12 days to 5 years with ARDS and hypoxaemic respiratory failure on conventional ventilation (CV), using a lung protective strategy, were managed with HFOV early in the course of the disease process (median length of CV 4 h). Arterial blood gases, oxygenation index (OI), alveolar-arterial oxygen difference (P(A-a)O2) and PaO2/FIO2 ratio were prospectively recorded prior to HFOV (0 h) and at predetermined intervals throughout the course of the HFOV protocol. There was a significant improvement in PaCO2 4 h after institution of HFOV ( P =0.012). A significant and sustained increase ( P <0.001) in PaO2/FIO2 ratio and a significant and sustained decrease ( P <0.001) in OI and P(A-a)O2 were demonstrated during the HFOV trial. These improvements were achieved 4 h after initiating HFOV ( P <0.05). Eight patients survived. There were no deaths from respiratory failure. Conclusion: In paediatric patients with acute respiratory distress syndrome and hypoxaemic respiratory failure on conventional ventilation, using a lung protective strategy, high-frequency oscillatory ventilation used as an “early rescue” therapy, improves gas exchange in a rapid and sustained fashion and provides a good outcome. Use of this therapy should probably be considered early in the course of the disease process.

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Fig. 1

Abbreviations

ARDS :

acute respiratory distress syndrome

CV :

conventional ventilation

HFOV :

high-frequency oscillatory ventilation

MAP :

mean airway pressure

OI :

oxygenation index

P(A-a)O 2 :

alveolar-arterial oxygen difference

PEEP :

positive end-expiratory pressure

PIP :

peak inspiratory pressure

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Correspondence to Nejla Ben Jaballah.

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Ben Jaballah, N., Mnif, K., Bouziri, A. et al. High-frequency oscillatory ventilation in paediatric patients with acute respiratory distress syndrome—early rescue use. Eur J Pediatr 164, 17–21 (2005). https://doi.org/10.1007/s00431-004-1544-4

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Keywords

  • Adult respiratory distress syndrome
  • High-frequency ventilation
  • Mechanical ventilation
  • Paediatrics
  • Respiratory insufficiency