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. 2020 Jan 31;24(1):31.
doi: 10.1186/s13054-020-2741-x.

The impact of high frequency oscillatory ventilation on mortality in paediatric acute respiratory distress syndrome

Judith Ju-Ming Wong  1 , Siqi Liu  2 , Hongxing Dang  3 , Nattachai Anantasit  4 , Phuc Huu Phan  5 , Suwannee Phumeetham  6 , Suyun Qian  7 , Jacqueline Soo May Ong  8 , Chin Seng Gan  9 , Yek Kee Chor  10 , Rujipat Samransamruajkit  11 , Tsee Foong Loh  12 , Mengling Feng  2 , Jan Hau Lee  12 ; Pediatric Acute & Critical care Medicine Asian Network (PACCMAN)
Affiliations

The impact of high frequency oscillatory ventilation on mortality in paediatric acute respiratory distress syndrome

Judith Ju-Ming Wong et al. Crit Care. .

Abstract

Background: High-frequency oscillatory ventilation (HFOV) use was associated with greater mortality in adult acute respiratory distress syndrome (ARDS). Nevertheless, HFOV is still frequently used as rescue therapy in paediatric acute respiratory distress syndrome (PARDS). In view of the limited evidence for HFOV in PARDS and evidence demonstrating harm in adult patients with ARDS, we hypothesized that HFOV use compared to other modes of mechanical ventilation is associated with increased mortality in PARDS.

Methods: Patients with PARDS from 10 paediatric intensive care units across Asia from 2009 to 2015 were identified. Data on epidemiology and clinical outcomes were collected. Patients on HFOV were compared to patients on other modes of ventilation. The primary outcome was 28-day mortality and secondary outcomes were 28-day ventilator- (VFD) and intensive care unit- (IFD) free days. Genetic matching (GM) method was used to analyse the association between HFOV treatment with the primary outcome. Additionally, we performed a sensitivity analysis, including propensity score (PS) matching, inverse probability of treatment weighting (IPTW) and marginal structural modelling (MSM) to estimate the treatment effect.

Results: A total of 328 patients were included. In the first 7 days of PARDS, 122/328 (37.2%) patients were supported with HFOV. There were significant differences in baseline oxygenation index (OI) between the HFOV and non-HFOV groups (18.8 [12.0, 30.2] vs. 7.7 [5.1, 13.1] respectively; p < 0.001). A total of 118 pairs were matched in the GM method which found a significant association between HFOV with 28-day mortality in PARDS [odds ratio 2.3, 95% confidence interval (CI) 1.3, 4.4, p value 0.01]. VFD was indifferent between the HFOV and non-HFOV group [mean difference - 1.3 (95%CI - 3.4, 0.9); p = 0.29] but IFD was significantly lower in the HFOV group [- 2.5 (95%CI - 4.9, - 0.5); p = 0.03]. From the sensitivity analysis, PS matching, IPTW and MSM all showed consistent direction of HFOV treatment effect in PARDS.

Conclusion: The use of HFOV was associated with increased 28-day mortality in PARDS. This study suggests caution but does not eliminate equivocality and a randomized controlled trial is justified to examine the true association.

Keywords: Acute lung injury; Acute respiratory distress syndrome; Children; High-frequency ventilation; Mechanical ventilation; Paediatric intensive care unit.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Odds ratio and 95% CI for subgroup analysis. The odds ratio (OR) and 95% CI are represented as black dots and horizontal bars respectively. The subgroup analysis was performed 10 times, while each time exclude one centre from the 10 centres in this study. We observed that the ORs from the 10 experiments were all greater than 1, indicating the 10 centres had consistent harmful outcome of using HFOV in terms of 28-day mortality. The 95% confidence interval of the ORs also support our finding that HFOV was harmful. The p values in 9 out of 10 experiments were less than 0.05. By comparing the ORs and 95% CI from the subgroups, we found there was significant association of HFOV treatment with 28-day mortality in PARDS
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References

    1. Kinsella JP, Clark RH. High-frequency oscillatory ventilation in pediatric critical care. Crit Care Med. 1993;21(2):174–175. - PubMed
    1. Derdak S, Mehta S, Stewart TE, Smith T, Rogers M, Buchman TG, et al. High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med. 2002;166(6):801–808. - PubMed
    1. Bollen CW, van Well GT, Sherry T, Beale RJ, Shah S, Findlay G, et al. High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial [ISRCTN24242669] Critical care (London) 2005;9(4):R430–R439. - PMC - PubMed
    1. Ferguson ND, Chiche JD, Kacmarek RM, Hallett DC, Mehta S, Findlay GP, et al. Combining high-frequency oscillatory ventilation and recruitment maneuvers in adults with early acute respiratory distress syndrome: the Treatment with Oscillation and an Open Lung Strategy (TOOLS) trial pilot study. Crit Care Med. 2005;33(3):479–486. - PubMed
    1. Sklar MC, Fan E, Goligher EC. High-frequency oscillatory ventilation in adults with ARDS: past, present, and future. Chest. 2017;152(6):1306–1317. - PubMed

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