Abstract
Objective
To assess the hemodynamic effects of high mean proximal airway pressures (Paw) during high-frequency oscillatory ventilation (HFOV) in non-neonatal pediatrics patients with severe respiratory failure.
Design
Prospective and retrospective study.
Setting
Pediatric ICU in a university-affiliated hospital.
Patients
8 non-neonatal pediatric patients with severe respiratory failure ventilated with HFOV at our institution between July 1991 and February 1994. All patients had a pulmonary artery catheter.
Interventions
HFOV.
Measurements and results
Higher Paw was required during HFOV to obtain adequate lung expansion during the first 24 h (median 20.9 cmH2O, range 16.9–30.0 cmH2O in CMV, versus median 30.0 cmH2O, range 21.0–33.0 cmH2O in HFOV,p=0.008), resulting in improved oxygenation as evaluated by alveolar-arterial oxygen difference (median of 557.2 mmHg, range 360.4–607.8 mmHg in CMV, versus median of 410.5 mmHg, range 282.9–550.2 mmHg after 24 h of HFOV,p=0.03). The only observed effect on the cardiovascular system was a decrease in heart rate (median of 162, range 129–178 in CMV, versus median of 142, range 104–195 after 24 h of HFOV,p=0.03). Oxygen delivery, cardiac index, mean systemic arterial blood pressure, and pulmonary and systemic vascular resistances did not change significantly before and after HFOV in the patients as a group, although in one case a decrease in cardiac index and oxygen delivery was observed.
Conclusions
High-Paw HFOV must be used cautiously, but seems to have no discernible adverse effects on the cardiovascular system in most patients.
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Gutiérrez, J.A., Levin, D.L. & Toro-Figueroa, L.O. Hemodynamic effects of high-frequency oscillatory ventilation in severe pediatric respiratory failure. Intensive Care Med 21, 505–510 (1995). https://doi.org/10.1007/BF01706204
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DOI: https://doi.org/10.1007/BF01706204