Anest. intenziv. Med. 2010;21(5):245-250

Effect of early use of high frequency oscillation in children with respiratory failureIntensive Care Medicine - Original Paper

Koudelková Ludmila^*, Košut Peter, Žurek Jiří, Marek Lukáš, Fedora Michal

Klinika dětské anesteziologie a resuscitace, Pracoviště dětské medicíny, Fakultní nemocnice Brno

Objective:
To demonstrate the effect of high frequency oscillation (HFOV) on gas exchange in children with ARDS. To compare the groups with early and late application of HFOV for different variables.

Design:
Retrospective analysis of the group of patients hospitalized from January 1994 to December 2006.
Setting:
Department of Paediatric Anaesthesiology and Resuscitation, University Hospital.

Materials and methods:
Fifty patients with severe hypoxaemic respiratory failure were included. The patients were included in the "early" group (n = 30, 60%) if commenced on HFOV within 24 hours of initiating mechanical ventilation, or in the "late" group if HFOV was commenced later than that. We studied the demographic data, PRISM score, primary diagnosis, time of ventilation, variables of acid-base balance, indexed variables (AaDO₂, OI, PaO₂/FiO₂) and the oscilator settings (Paw, FiO₂). Evaluation of the group mortality was performed.

Results:
In both the groups pH and PaCO₂ values improved achieving normal values. The early commencement group showed significant improvement in the values of AaDO₂, PaO₂/FiO₂ and OI. The late commencement group did not show significant difference compared with baseline. Significant differences in the values of Paw were observed between the groups and a necessity for higher Paw setting in the late commencement group was evident. It was possible to decrease FiO₂ faster in the early commencement group compared with the late commencement group. The mortality was 53 % in the early commencement group compared with 75 % in the late commencement group.

Conclusion:
Early switch to HFOV had a positive influence on ventilation and oxygenation. Significant beneficial difference between the groups was observed mainly in AaDO₂, PaO₂/FiO₂ and OI. The observed difference in mortality was not statistically significant but it could point to the ideal timing of commencing the patient on HFOV.

Keywords: respiratory failure; ARDS; children; high frequency oscillatory ventilation

Received: March 4, 2010; Accepted: July 14, 2010; Published: October 1, 2010  Show citation