High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure

Abstract

Summary Background Airway pressure release ventilation (APRV) and high frequency oscillatory ventilation (HFOV) are frequently used in acute lung injury (ALI) refractory to conventional ventilation. Our aim was to describe our experience with APRV and HFOV in refractory pediatric ALI, and to identify factors associated with survival. Methods We analyzed 104 patients with hypoxemia refractory to conventional ventilation transitioned to either APRV or HFOV. Demographics, oxygenation index (OI), and PaO2/FiO2 (PF ratio) were recorded before transition to either mode of nonconventional ventilation (NCV) and for every 12 hr after transition. Results Relative to APRV, patients on HFOV were younger and had more significant lung disease evidenced by higher OI (28.5 [18.6, 36.2] vs. 21.0 [15.5, 30.0], P = 0.008), lower PF ratios (73 [59,94] vs. 99 [76,131], P = 0.002), and more frequent use of inhaled nitric oxide. In univariate analysis, HFOV was associated with more frequent neuromuscular blockade. Forty-one of 104 patients died on NCV (39.4%). Survivors demonstrated improvement in OI 24 hr after transition to NCV, whereas non-survivors did not (12.9 [8.9, 20.9] vs. 28.1 [17.6, 37.1], P < 0.001). After controlling for immunocompromised status, number of vasopressors, and OI before transition, mode of NCV was not associated with mortality. Conclusions In a heterogeneous PICU population with hypoxemia refractory to conventional ventilation transitioned to NCV, improvement in oxygenation at 24 hr was associated with survival. Immunocompromised status, number of vasopressor infusions, and the OI before transition to NCV were independently associated with survival.

Corticosteroid exposure in pediatric acute respiratory distress syndrome

“…Non-pulmonary organ failures at time of PARDS diagnosis were identified using standard definitions for children [24]. The designation of ''immunocompromised'' required presence of an immunocompromising diagnosis (oncologic, immunologic, rheumatologic, or transplant) and active immunosuppressive chemotherapy, or a congenital immunodeficiency [25,26]. Severity of illness score used was the Pediatric Risk of Mortality (PRISM) III at 12 h.…”

High frequency oscillatory ventilation in a cohort of children with respiratory failure

“…Several factors appear to impact survival for children needing HFOV support with notable factors being the presence of an immunocompromised condition (IC) and markers of oxygenation, specifically the oxygenation index (OI) . The utility of the OI in discriminating survivors from non‐survivors has been examined in multiple studies . Both the OI prior to HFOV initiation and the OI ratio (OI at 24 h/OI prior to HFOV initiation) may be useful in predicting outcome.…”

Factors associated with interhospital transfer of children with respiratory failure from level II to level I pediatric intensive care units

“…High frequency oscillatory ventilation (HFOV) is often deployed as rescue therapy among critically ill children with severe hypoxemic respiratory failure that is unresponsive to conventional modes of ventilator therapy [17, 18]. In a prior single center study of children transferred from Level II to Level I PICU care, 25% of them required extracorporeal membrane oxygenation therapy, an invasive therapy reserved for failure of conventional and non-conventional ventilator therapy for hypoxemic respiratory failure [5].…”