Scot T Bateman1, Santiago Borasino2, Lisa A Asaro3, Ira M Cheifetz4, Shelley Diane5, David Wypij3,6,7, Martha A Q Curley8,9,10. 1. 1 Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts. 2. 2 Department of Pediatrics, University of Alabama, Birmingham, Alabama. 3. 3 Department of Cardiology and. 4. 4 Department of Pediatrics, Duke University Medical Center, Durham, North Carolina. 5. 5 Department of Pediatrics, University of California, San Francisco, San Francisco, California. 6. 6 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. 7. 7 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and. 8. 10 Department of Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts. 9. 8 Department of Family and Community Health, School of Nursing and. 10. 9 Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
RATIONALE: The use of high-frequency oscillatory ventilation (HFOV) for acute respiratory failure in children is prevalent despite the lack of efficacy data. OBJECTIVES: To compare the outcomes of patients with acute respiratory failure managed with HFOV within 24-48 hours ofendotracheal intubation with those receiving conventional mechanical ventilation (CMV) and/or late HFOV. METHODS: This is a secondary analysis of data from the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) study, a prospective cluster randomized clinical trial conducted between 2009 and 2013 in 31 U.S. pediatric intensive care units. Propensity score analysis, including degree of hypoxia in the model, compared the duration of mechanical ventilation and mortality of patients treated with early HFOV matched with those treated with CMV/late HFOV. MEASUREMENTS AND MAIN RESULTS: Among 2,449 subjects enrolled in RESTORE, 353 patients (14%) were ever supported on HFOV, of which 210 (59%) had HFOV initiated within 24-48 hours of intubation. The propensity score model predicting the probability of receiving early HFOV included 1,064 patients (181 early HFOV vs. 883 CMV/late HFOV) with significant hypoxia (oxygenation index ≥ 8). The degree of hypoxia was the most significant contributor to the propensity score model. After adjusting for risk category, early HFOV use was associated with a longer duration of mechanical ventilation (hazard ratio, 0.75; 95% confidence interval, 0.64-0.89; P = 0.001) but not with mortality (odds ratio, 1.28; 95% confidence interval, 0.92-1.79; P = 0.15) compared with CMV/late HFOV. CONCLUSIONS: In adjusted models including important oxygenation variables, early HFOV was associated with a longer duration of mechanical ventilation. These analyses make supporting the current approach to HFOV less convincing.
RCT Entities:
RATIONALE: The use of high-frequency oscillatory ventilation (HFOV) for acute respiratory failure in children is prevalent despite the lack of efficacy data. OBJECTIVES: To compare the outcomes of patients with acute respiratory failure managed with HFOV within 24-48 hours of endotracheal intubation with those receiving conventional mechanical ventilation (CMV) and/or late HFOV. METHODS: This is a secondary analysis of data from the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) study, a prospective cluster randomized clinical trial conducted between 2009 and 2013 in 31 U.S. pediatric intensive care units. Propensity score analysis, including degree of hypoxia in the model, compared the duration of mechanical ventilation and mortality of patients treated with early HFOV matched with those treated with CMV/late HFOV. MEASUREMENTS AND MAIN RESULTS: Among 2,449 subjects enrolled in RESTORE, 353 patients (14%) were ever supported on HFOV, of which 210 (59%) had HFOV initiated within 24-48 hours of intubation. The propensity score model predicting the probability of receiving early HFOV included 1,064 patients (181 early HFOV vs. 883 CMV/late HFOV) with significant hypoxia (oxygenation index ≥ 8). The degree of hypoxia was the most significant contributor to the propensity score model. After adjusting for risk category, early HFOV use was associated with a longer duration of mechanical ventilation (hazard ratio, 0.75; 95% confidence interval, 0.64-0.89; P = 0.001) but not with mortality (odds ratio, 1.28; 95% confidence interval, 0.92-1.79; P = 0.15) compared with CMV/late HFOV. CONCLUSIONS: In adjusted models including important oxygenation variables, early HFOV was associated with a longer duration of mechanical ventilation. These analyses make supporting the current approach to HFOV less convincing.
Authors: Laurent Papazian; Jean-Marie Forel; Arnaud Gacouin; Christine Penot-Ragon; Gilles Perrin; Anderson Loundou; Samir Jaber; Jean-Michel Arnal; Didier Perez; Jean-Marie Seghboyan; Jean-Michel Constantin; Pierre Courant; Jean-Yves Lefrant; Claude Guérin; Gwenaël Prat; Sophie Morange; Antoine Roch Journal: N Engl J Med Date: 2010-09-16 Impact factor: 91.245
Authors: Marcelo B P Amato; Maureen O Meade; Arthur S Slutsky; Laurent Brochard; Eduardo L V Costa; David A Schoenfeld; Thomas E Stewart; Matthias Briel; Daniel Talmor; Alain Mercat; Jean-Christophe M Richard; Carlos R R Carvalho; Roy G Brower Journal: N Engl J Med Date: 2015-02-19 Impact factor: 91.245
Authors: Katharina von der Hardt; Michael Andreas Kandler; Ludger Fink; Ellen Schoof; Jörg Dötsch; Olga Brandenstein; Rainer Maria Bohle; Wolfgang Rascher Journal: Pediatr Res Date: 2003-12-08 Impact factor: 3.756
Authors: Duncan Young; Sarah E Lamb; Sanjoy Shah; Iain MacKenzie; William Tunnicliffe; Ranjit Lall; Kathy Rowan; Brian H Cuthbertson Journal: N Engl J Med Date: 2013-01-22 Impact factor: 91.245
Authors: Courtney M Rowan; Margaret J Klein; Deyin Doreen Hsing; Mary K Dahmer; Philip C Spinella; Guillaume Emeriaud; Amanda B Hassinger; Byron E Piñeres-Olave; Heidi R Flori; Bereketeab Haileselassie; Yolanda M Lopez-Fernandez; Ranjit S Chima; Steven L Shein; Aline B Maddux; Jon Lillie; Ledys Izquierdo; Martin C J Kneyber; Lincoln S Smith; Robinder G Khemani; Neal J Thomas; Nadir Yehya Journal: Am J Respir Crit Care Med Date: 2020-06-01 Impact factor: 21.405
Authors: Courtney M Rowan; Ashley Loomis; Jennifer McArthur; Lincoln S Smith; Shira J Gertz; Julie C Fitzgerald; Mara E Nitu; Elizabeth As Moser; Deyin D Hsing; Christine N Duncan; Kris M Mahadeo; Jerelyn Moffet; Mark W Hall; Emily L Pinos; Robert F Tamburro; Ira M Cheifetz Journal: Respir Care Date: 2017-12-26 Impact factor: 2.258
Authors: Debra Boyer; Carey C Thomson; Robyn Cohen; Devika Rao; Sharon Dell; Jonathan Rayment; Ruobing Wang; Fei J Dy; Jennifer Wambach; Jade Tam-Williams; Dawn Simon; Eric Price; Christopher M Oermann; Alvin Singh; Jordan S Rettig; Elizabeth D Duncan; Christopher D Baker; Deborah R Liptzin; Paul E Moore Journal: Ann Am Thorac Soc Date: 2016-06
Authors: Scott L Weiss; Mark J Peters; Waleed Alhazzani; Michael S D Agus; Heidi R Flori; David P Inwald; Simon Nadel; Luregn J Schlapbach; Robert C Tasker; Andrew C Argent; Joe Brierley; Joseph Carcillo; Enitan D Carrol; Christopher L Carroll; Ira M Cheifetz; Karen Choong; Jeffry J Cies; Andrea T Cruz; Daniele De Luca; Akash Deep; Saul N Faust; Claudio Flauzino De Oliveira; Mark W Hall; Paul Ishimine; Etienne Javouhey; Koen F M Joosten; Poonam Joshi; Oliver Karam; Martin C J Kneyber; Joris Lemson; Graeme MacLaren; Nilesh M Mehta; Morten Hylander Møller; Christopher J L Newth; Trung C Nguyen; Akira Nishisaki; Mark E Nunnally; Margaret M Parker; Raina M Paul; Adrienne G Randolph; Suchitra Ranjit; Lewis H Romer; Halden F Scott; Lyvonne N Tume; Judy T Verger; Eric A Williams; Joshua Wolf; Hector R Wong; Jerry J Zimmerman; Niranjan Kissoon; Pierre Tissieres Journal: Intensive Care Med Date: 2020-02 Impact factor: 17.440
Authors: Christopher J L Newth; Katherine A Sward; Robinder G Khemani; Kent Page; Kathleen L Meert; Joseph A Carcillo; Thomas P Shanley; Frank W Moler; Murray M Pollack; Heidi J Dalton; David L Wessel; John T Berger; Robert A Berg; Rick E Harrison; Richard Holubkov; Allan Doctor; J Michael Dean; Tammara L Jenkins; Carol E Nicholson Journal: Pediatr Crit Care Med Date: 2017-11 Impact factor: 3.624