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. 2023 Sep-Oct;43(5):283-290.
doi: 10.5144/0256-4947.2023.283. Epub 2023 Oct 5.

The outcome of high-frequency oscillatory ventilation in pediatric patients with acute respiratory distress syndrome in an intensive care unit

Tareq Al-Ayed  1 , Iyad B Alsarhi  2 , Abdullah Alturki  1 , Fahad Aljofan  1 , Tariq Alofisan  1 , Moath Al Abdulsalam  1 , Deema Gashgarey  3 , Rwan Alrwili  3 , Wala Aldihan  3 , Saleh Badr Bin Mahfodh  2 , Fawaz Alanzi  3 , Ahmed M Otaibi  4 , Raghad Tariq Alhuthil  3
Affiliations

The outcome of high-frequency oscillatory ventilation in pediatric patients with acute respiratory distress syndrome in an intensive care unit

Tareq Al-Ayed et al. Ann Saudi Med. 2023 Sep-Oct.

Abstract

Background: In adults with acute respiratory distress syndrome (ARDS), high-frequency oscillatory ventilation (HFOV) has been associated with higher mortality rates. Therefore, its use in children with ARDS is still controversial.

Objectives: Evaluate the overall mortality of HFOV in children with ARDS and explore mortality-related risk factors; compare the outcome of using HFOV post-endotracheal intubation early (≤24 hours) versus late (≤24 hours).

Design: Retrospective (medical record review) SETTING: Pediatric intensive care unit in a tertiary care center in Saudi Arabia.

Patients and methods: Data were collected from medical records of all pediatric patients with ARDS aged one week to 14 years, who were admitted to the pediatric intensive care unit (PICU) from January 2016-June 2019 and who required HFOV.

Main outcome measures: PICU mortality.

Sample size and characteristics: 135 ARDS patients including 74 females (54.8%), and 61 males (45.2%), with a median age (interquar-tile range) of 35 (72) months.

Results: The overall mortality rate was 60.0% (81/135), and most died in the first 28 days in the PICU (91.3%, 74/8). Of non-survivors, 75.3% (61/81) were immunocompromised, and 24.7% (20/81) were immuno-competent patients, 52 (64.2%) received inotropic support, 40 (49.4%) had a bone-marrow transplant (BMT) before HFOV initiation. Although the prone position was used in 20.7% (28/135) to improve the survival rate post-HFOV ventilation, only 28.6% (8/28) survived. In addition, altered code status or chemotherapy reported a significant association with mortality (P<.05). Interestingly, early HFOV initiation (≤24 hours) did not seem to have a high impact on survival compared to late initiation (>24 hours); (57.4% vs. 42.6%, P=.721).

Conclusion: Immunocompromised and oncology patients, including post-BMT, reported poorer outcomes, and neither the prone position nor early use of HFOV improved outcomes. However, it is recommended to replicate the study in a larger cohort to generalize the results.

Limitations: Retrospective single-center study.

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Conflict of interest statement

CONFLICT OF INTEREST: None.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curve of patients who expired within 28 days of the PICU stay. The number in parentheses represents the number of deaths for each time period.
See this image and copyright information in PMC

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