High-frequency oscillatory ventilation in children with acute respiratory distress syndrome: experience of a pediatric intensive care unit

Objective

To describe the effects of high-frequency oscillatory ventilation (HFOV) as a rescue ventilatory support in pediatric patients with acute respiratory distress syndrome (ARDS).

Methods

Twenty-five children (1 month < age < 17 years) admitted to a university hospital pediatric intensive care unit (ICU) with ARDS and submitted to HFOV for a minimum of 48 hours after failure of conventional mechanical ventilation were assessed.

Results

28 days after the onset of ARDS, the mortality rate was 52% (13/25). Over the course of 48 hours, the use of HFOV reduced the oxygenation index [38 (31–50) vs. 17 (10 - 27)] and increased the ratio of partial arterial pressure O₂ and fraction of inspired O₂ [65 [44–80) vs. 152 (106–213)]. Arterial CO₂ partial pressure [54 (45–74) vs. 48 (39–58) mmHg] remained unchanged. The mean airway pressure ranged between 23 and 29 cmH₂O. HFOV did not compromise hemodynamics, and a reduction in heart rate was observed (141 ± 32 vs. 119 ± 22 beats/min), whereas mean arterial pressure (66 ± 20 vs. 71 ± 17 mmHg) and inotropic score [44 (17–130) vs. 20 (16–75)] remained stable during this period. No survivors were dependent on oxygen.

Conclusion

HFOV improves oxygenation in pediatric patients with ARDS and severe hypoxemia refractory to conventional ventilatory support.