E L Duval1, D G Markhorst, R J Gemke, A J van Vught. 1. Pediatric Intensive Care Unit, University Children's Hospital Het Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands.
Abstract
BACKGROUND: High-frequency oscillatory ventilation (HFOV) is a ventilatory mode using small tidal volumes with low phasic pressures at supraphysiological frequencies. Beyond the neonatal period there are distinct lung diseases for which HFOV is used. Data of 35 children who deteriorated on conventional ventilation were retrospectively analysed in two tertiary pediatric intensive care units. METHODS: Depending on the underlying pulmonary pathophysiology, three strategies were employed. First, the 'open-lung' strategy designed to rapidly recruit and maintain optimal lung volume in DAD (n=27) and pulmonary hemorrhage (n=5). Second, the 'low-volume' strategy in persistent air leak (n=1) where, after an initial identical approach, mean airway pressure (MAP) is reduced until the air leak ceases. Third, the 'open-airway' strategy in obstructive airway disease (n=5) where MAP is used to recruit and stent the airways. RESULTS: Seven patients died, two due to respiratory failure. Three patients developed an air leak. Nine patients developed chronic lung disease. There was a significant decrease of the oxygenation index (OI) in the survivors. In the two patients who died of respiratory failure, the OI increased. CONCLUSION: If certain conditions are met, HFOV appears a safe and effective mode of ventilation in pediatric respiratory failure.
BACKGROUND: High-frequency oscillatory ventilation (HFOV) is a ventilatory mode using small tidal volumes with low phasic pressures at supraphysiological frequencies. Beyond the neonatal period there are distinct lung diseases for which HFOV is used. Data of 35 children who deteriorated on conventional ventilation were retrospectively analysed in two tertiary pediatric intensive care units. METHODS: Depending on the underlying pulmonary pathophysiology, three strategies were employed. First, the 'open-lung' strategy designed to rapidly recruit and maintain optimal lung volume in DAD (n=27) and pulmonary hemorrhage (n=5). Second, the 'low-volume' strategy in persistent air leak (n=1) where, after an initial identical approach, mean airway pressure (MAP) is reduced until the air leak ceases. Third, the 'open-airway' strategy in obstructive airway disease (n=5) where MAP is used to recruit and stent the airways. RESULTS: Seven patients died, two due to respiratory failure. Three patients developed an air leak. Nine patients developed chronic lung disease. There was a significant decrease of the oxygenation index (OI) in the survivors. In the two patients who died of respiratory failure, the OI increased. CONCLUSION: If certain conditions are met, HFOV appears a safe and effective mode of ventilation in pediatric respiratory failure.
Authors: Fieke Y A M Slee-Wijffels; Klara R M van der Vaart; Jos W R Twisk; Dick G Markhorst; Frans B Plötz Journal: Crit Care Date: 2005-04-08 Impact factor: 9.097
Authors: Martin C J Kneyber; Daniele de Luca; Edoardo Calderini; Pierre-Henri Jarreau; Etienne Javouhey; Jesus Lopez-Herce; Jürg Hammer; Duncan Macrae; Dick G Markhorst; Alberto Medina; Marti Pons-Odena; Fabrizio Racca; Gerhard Wolf; Paolo Biban; Joe Brierley; Peter C Rimensberger Journal: Intensive Care Med Date: 2017-09-22 Impact factor: 17.440