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. 2016 Mar;5(1):12-20.
doi: 10.1055/s-0035-1568160. Epub 2015 Nov 30.

Use of High-Frequency Ventilation in the Pediatric Intensive Care Unit

Daniel S Tawfik  1 , Tellen D Bennett  2   3 , Brent Welch  4 , W Bradley Poss  1   5
Affiliations

Use of High-Frequency Ventilation in the Pediatric Intensive Care Unit

Daniel S Tawfik et al. J Pediatr Intensive Care. 2016 Mar.

Abstract

Objective To evaluate the clinical characteristics, ventilator settings, and gas exchange indices of patients placed on high-frequency percussive ventilation (HFPV) and high-frequency oscillatory ventilation (HFOV). Methods Retrospective observation of all consecutive patients aged 0 to 18 years with acute respiratory failure managed with high-frequency ventilation from the institution's introduction of HFPV on May 1, 2012, until July 10, 2013. Measurements and Main Results Twenty-seven patients underwent HFPV as a first mode of high-frequency ventilation and 16 patients underwent HFOV first. HFPV was used more frequently in patients with acute respiratory illnesses (p < 0.01), lower Pediatric Index of Mortality 2 scores (rank-sum p < 0.04), higher Spo 2/Fio 2 (SF) ratios (p < 0.01), and lower oxygen saturation indices (p < 0.01). HFPV patients showed increased SF ratios (p < 0.01) and decreased Paco 2 levels (p = 0.02) 6 hours after initiation, and HFOV patients showed no significant differences. Peak inspiratory pressures (HFPV) and mean airway pressures (HFOV) remained at or below 30 cm H2O at each time point. HFPV and HFOV patients had an average of 2.8 and 2.9 mode changes, respectively. Mortality was 15% in the HFPV group and 50% in the HFOV group. Conclusions HFPV is associated with rapid improvement in oxygenation and ventilation at acceptable airway pressures in patients with acute respiratory failure of various etiologies, primarily for those with difficulties of ventilation or secretion management. In our institution, HFOV appears to be initiated first in children with higher severity of illness.

Keywords: acute lung injury; acute respiratory failure; high-frequency oscillatory ventilation; high-frequency percussive ventilation; high-frequency ventilation.

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Figures

Fig. 1
Fig. 1
VDR-4 ventilator screen image showing the high-frequency percussive ventilation pressure scalar. Used with permission.
Fig. 2
Fig. 2
Progression of study patients through modes of ventilation.
Fig. 3
Fig. 3
Mean oxygenation saturation indices with 95% confidence intervals and linear regressions from prior to initiation (time 0) and throughout course of high-frequency percussive ventilation (HFPV) and high-frequency oscillatory ventilation (HFOV).
Fig. 4
Fig. 4
Mean partial pressure of carbon dioxide in mm Hg with 95% confidence intervals and linear regressions from prior to initiation (time 0) and throughout course of high-frequency percussive ventilation (HFPV) and high-frequency oscillatory ventilation (HFOV).
Fig. 5
Fig. 5
Mean values of mean airway pressure with 95% confidence intervals and linear regressions from prior to initiation (time 0) and throughout course of high-frequency percussive ventilation (HFPV) and high-frequency oscillatory ventilation (HFOV).
See this image and copyright information in PMC

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