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Outcomes of Severe PARDS on High-Frequency Oscillatory Ventilation – A Single Centre Experience

  • Arpita Chattopadhyay
  • Samriti Gupta
  • Jhuma Sankar
  • Sushil K. Kabra
  • Rakesh LodhaEmail author
Original Article

Abstract

Objective

To describe experience with high-frequency oscillatory ventilation (HFOV) in children with acute respiratory distress syndrome (ARDS) transitioned from conventional mechanical ventilation (CMV) due to refractory hypoxemia and to assess factors associated with survival and also compare outcomes of patients who were managed with early HFOV (within 24 h of intubation) vs. late HFOV.

Methods

This retrospective, observational study was conducted in a tertiary care hospital's pediatric intensive care unit. Thirty-four children with pediatric acute respiratory distress syndrome (PARDS) managed with HFOV were included.

Results

Of 34 children with PARDS managed with HFOV after failure of conventional ventilation to improve oxygenation, 8 survived. Improvement in the Oxygenation Index (OI) at 48 h of initiation of HFOV along with percent increase in PaO2/FiO2 (P/F ratio) at 24 h of HFOV were predictors of survival. The response to HFOV, based on OI and P/F ratio, between 24 and 48 h of ventilation identified potential survivors. Also, lower positive end-expiratory pressure (PEEP) on CMV and shorter duration of CMV before initiation of HFOV were associated with survival.

Conclusions

Survival in pediatric ARDS patients treated with HFOV could be predicted by using trends of OI – with survivors showing a more rapid decline in OI between 24 and 48 h of initiation compared to non-survivors.

Keywords

High-frequency oscillatory ventilation Conventional mechanical ventilation Pediatric ARDS 

Notes

Authors’ Contribution

RL and AC conceptualised the hypothesis for study. AC and SG collected the data. RL, AC, JS and SKK reviewed the manuscript. All authors consented to publication of article. RL is the guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest

None.

References

  1. 1.
    Wong JJ, Jit M, Sultana R, et al. Mortality in pediatric acute respiratory distress syndrome: a systematic review and meta-analysis. J Intensive Care Med. 2019;34:563–71.CrossRefGoogle Scholar
  2. 2.
    Khemani RG, Smith LS, Zimmerman JJ, Erickson S; Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology. Pediatr Crit Care Med. 2015;16:S23–40.CrossRefGoogle Scholar
  3. 3.
    Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med. 1998;157:1–30.CrossRefGoogle Scholar
  4. 4.
    Arnold JH, Hanson JH, Toro-Figuero LO, Gutiérrez J, Berens RJ, Anglin DL. Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med. 1994;22:1530–9.CrossRefGoogle Scholar
  5. 5.
    Young D, Lamb SE, Shah S, et al; OSCAR Study Group. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 2013;368:806–13.CrossRefGoogle Scholar
  6. 6.
    Ferguson ND, Cook DJ, Guyatt GH, et al; OSCILLATE Trial investigators, Canadian Critical Care Trials Group. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013;368:795–805.CrossRefGoogle Scholar
  7. 7.
    Rettig JS, Smallwood CD, Walsh BK, et al. High-frequency oscillatory ventilation in pediatric acute lung injury: a multicenter international experience. Crit Care Med. 2015;43:2660–7.CrossRefGoogle Scholar
  8. 8.
    Ben Jaballah N, Khaldi A, Mnif K, et al. High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure. Pediatr Crit Care Med. 2006;7:362–7.CrossRefGoogle Scholar
  9. 9.
    Slee-Wijffels FY, Vaartvd KR, Twisk JWR, Markhorst DG, Plötz FB. High-frequency oscillatory ventilation in children: a single-center experience of 53 cases. Crit Care. 2005;9:R274–9.CrossRefGoogle Scholar
  10. 10.
    Arnold JH, Anas NG, Luckett P, et al. High-frequency oscillatory ventilation in pediatric respiratory failure: a multicenter experience. Crit Care Med. 2000;28:3913–9.CrossRefGoogle Scholar
  11. 11.
    Duval EL, Markhorst DG, van Vught AJ. High frequency oscillatory ventilation in children: an overview. Respir Med CME. 2009;2:155–61.CrossRefGoogle Scholar
  12. 12.
    Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92:2226–35.CrossRefGoogle Scholar
  13. 13.
    Gupta P, Green JW, Tang X, et al. Comparison of high frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. JAMA Pediatr. 2014;168:243–9.CrossRefGoogle Scholar
  14. 14.
    Saharan S, Lodha R, Kabra SK. Management of acute lung injury/ acute respiratory distress syndrome. Indian J Pediatr. 2010;77:1296–302.CrossRefGoogle Scholar
  15. 15.
    Popernack ML, Thomas NJ, Lucking SE. Decreasing unplanned extubations: utilization of the Penn State Children's hospital sedation algorithm. Pediatr Crit Care Med. 2004;5:58–62.CrossRefGoogle Scholar
  16. 16.
    Dellinger RP, Levy MM, Rhodes A, et al; Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.CrossRefGoogle Scholar
  17. 17.
    Yehya N, Topjian AA, Thomas NJ, Friess SH. Improved oxygenation 24 hours after transition to airway pressure release ventilation or high frequency oscillatory ventilation accurately discriminates survival in immunocompromised pediatric patients with acute respiratory distress syndrome. Pediatr Crit Care Med. 2014;15:e147–56.CrossRefGoogle Scholar
  18. 18.
    Yehya N, Topjian AA, Lin R, Berg RA, Thomas NJ, Friess SH. High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure. Pediatr Pulmonol. 2014;49:707–15.CrossRefGoogle Scholar
  19. 19.
    Camporota L, Sherry T, Smith J, Lei K, McLuckie A, Beale R. Physiological predictors of survival during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care. 2013;17:R40.CrossRefGoogle Scholar
  20. 20.
    Mehta S, Granton J, MacDonald RJ, et al. High-frequency oscillatory ventilationin adults: the Toronto experience. Chest. 2004;126:518–27.CrossRefGoogle Scholar
  21. 21.
    Yu WL, Lu ZJ, Wang Y, et al; Collaborative Study Group of Pediatric Respiratory Failure. The epidemiology of acute respiratory distress syndrome in pediatric intensive care units in China. Intensive Care Med. 2009;35:136–43.CrossRefGoogle Scholar
  22. 22.
    Pinzon AD, Rocha TS, Ricachinevsky C, Piva JP, Friedman G. High-frequency oscillatory ventilation in children with acute respiratory distress syndrome: experience of a pediatric intensive care unit. Rev Assoc Med Bras (1992). 2013;59:368–74.CrossRefGoogle Scholar
  23. 23.
    Babbitt CJ, Cooper MC, Nussbaum E, Liao E, Levine GK, Randhawa IS. High-frequency oscillatory ventilation in pediatric acute hypoxemic respiratory failure: disease-specific morbidity survival analysis. Lung. 2012;190:685–90.CrossRefGoogle Scholar
  24. 24.
    Bateman ST, Borasino S, Asaro LA, et al; RESTORE Study Investigators. Early high-frequency oscillatory ventilation in pediatric acute respiratory failure. A propensity score analysis. Am J Respir Crit Care Med. 2016;193:495–503.CrossRefGoogle Scholar
  25. 25.
    van Genderingen HR, van Vught AJ, Duval E, Markhorst DG, Jansen JR. Attenuation of pressure swings along the endotracheal tube is indicative of optimal distending pressure during high frequency oscillatory ventilation in a model of acute lung injury. Pediatr Pulmonol. 2002;33:429–36.CrossRefGoogle Scholar
  26. 26.
    van Heerde M, Roubik K, Kopelent V, Plötz FB, Markhorst DG. Demand flow facilitates spontaneous breathing during high-frequency oscillatory ventilation in a pig model. Crit Care Med. 2009;37:1068–73.CrossRefGoogle Scholar
  27. 27.
    van Heerde M, van Genderingen HR, Leenhoven T, Roubik K, Plötz FB, Markhorst DG. Imposed work of breathing during high-frequency oscillatory ventilation: a bench study. Crit Care. 2006;10:R23.CrossRefGoogle Scholar
  28. 28.
    Laubscher B, van Melle G, Fawer CL, Sekarski N, Calame A. Haemodynamic changes during high frequency oscillation for respiratory distress syndrome. Arch Dis Child Fetal Neonatal. 1996;74:F172–6.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2020

Authors and Affiliations

  • Arpita Chattopadhyay
    • 1
  • Samriti Gupta
    • 1
  • Jhuma Sankar
    • 1
  • Sushil K. Kabra
    • 1
  • Rakesh Lodha
    • 1
    Email author
  1. 1.Division of Pediatric Pulmonology and Intensive Care, Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia

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