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. 2021 Feb;56(2):502-508.
doi: 10.1002/ppul.25191. Epub 2020 Dec 8.

High frequency percussive ventilation in pediatric acute respiratory failure

Andrew D Butler  1 , Cheryl L Dominick  2 , Nadir Yehya  1
Affiliations

High frequency percussive ventilation in pediatric acute respiratory failure

Andrew D Butler et al. Pediatr Pulmonol. 2021 Feb.

Abstract

Objective: High frequency percussive ventilation (HFPV) is used in acute respiratory failure, but is poorly described in pediatrics. We aimed to describe the clinical characteristics, ventilator settings, and outcomes of a large pediatric cohort, and to determine predictors of who would benefit from HFPV.

Hypothesis: Gas exchange 2 h after HFPV initiation predicts success.

Design: Single center retrospective cohort study testing association between gas exchange 2 h after HFPV initiation with success, defined a priori.

Patients: Intubated children on HFPV for ≥2 h from 2012 to 2018.

Methods: We described indications, ventilator settings, and gas exchange immediately before, 2 h after, and at termination of HFPV. Univariate and multivariate regression tested association of oxygenation and ventilation after HFPV initiation with success. Areas under the receiver operating characteristic (AUROC) curve and adjusted odds ratios (aORs) were computed.

Results: We performed 237 courses of HFPV in 193 children (22% non-survivors), of which 162 (68%) were successful. In univariate analysis, pH (AUROC, 0.65) and PCO2 (AUROC, 0.66) 2 h after HFPV predicted success. In multivariate analysis, pH (aOR: 1.67 per 1 SD; 95% confidence interval [CI]: 1.19-2.35), PCO2 (aOR: 0.49 per 1 SD; 95% CI: 0.31-0.79), and oxygenation index (aOR: 0.66 per 1 SD; 95% CI: 0.44-0.97) 2 h after HFPV initiation were associated with success.

Conclusion: We describe the largest cohort of HFPV to date, with detailed description of indications and settings. Gas exchange after 2 h of HFPV was independently associated with success.

Keywords: ARF; HFPV; high frequency percussive ventilation; high frequency ventilation; nonconventional ventilation.

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Conflict of interest statement

Conflict: The authors declare no conflicts of interest, financial or otherwise.

Figures

Figure 1:
Figure 1:
Comparisons of pH, PCO2, and oxygenation index pre-HFPV and 2 hours post-HFPV. P values are the results of signed rank test for paired values.
Figure 2:
Figure 2:
Comparisons of pH, PCO2, and oxygenation index pre-HFPV and 2 hours post-HFPV, stratified by HFPV success or failure. P values are the results of signed rank test for paired values.
See this image and copyright information in PMC

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