Courtney M Rowan1, Ashley Loomis2, Jennifer McArthur3, Lincoln S Smith4, Shira J Gertz5, Julie C Fitzgerald6, Mara E Nitu7, Elizabeth As Moser8, Deyin D Hsing9, Christine N Duncan10, Kris M Mahadeo11, Jerelyn Moffet12, Mark W Hall13, Emily L Pinos14, Robert F Tamburro14, Ira M Cheifetz15. 1. Department of Pediatrics, Division of Critical Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN. coujohns@iu.edu. 2. Department of Pediatrics, Division of Critical Care, University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, MN. 3. Department of Pediatrics, Division of Critical Care, St. Jude's Children's Research Hospital, Memphis, TN. 4. Department of Pediatrics, Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA. 5. Department of Pediatrics, Division of Critical Care, St. Barnabas Medical Center, Livingston, NJ. 6. Department of Anesthesiology and Critical Care, Division of Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 7. Department of Pediatrics, Division of Critical Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN. 8. Department of Biostatistics, Indiana University, Indianapolis, IN. 9. Department of Pediatrics, Division of Critical Care, Weil Cornell Medical College, New York Presbyterian Hospital, New York, NY. 10. Department of Pediatrics, Division of Oncology, Dana-Farber Cancer Institute Harvard University, Boston, MA. 11. Department of Pediatrics, Division of Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY. 12. Department of Pediatrics, Division of Blood and Marrow Transplant, Duke Children's Hospital, Duke University, Durham, NC. 13. Department of Pediatrics, Division of Critical Care, Nationwide Children's Hospital, The Ohio State University, Columbus, OH. 14. Department of Pediatrics, Division of Critical Care, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, PA. 15. Department of Pediatrics, Division of Critical Care, Duke Children's Hospital, Duke University, Durham, NC.
Abstract
INTRODUCTION: The effectiveness of high-frequency oscillatory ventilation (HFOV) in the pediatric hematopoietic cell transplant patient has not been established. We sought to identify current practice patterns of HFOV, investigate parameters during HFOV and their association with mortality, and compare the use of HFOV to conventional mechanical ventilation in severe pediatric ARDS. METHODS: This is a retrospective analysis of a multi-center database of pediatric and young adult allogeneic hematopoietic cell transplant subjects requiring invasive mechanical ventilation for critical illness from 2009 through 2014. Twelve United States pediatric centers contributed data. Continuous variables were compared using a Wilcoxon rank-sum test or a Kruskal-Wallis analysis. For categorical variables, univariate analysis with logistic regression was performed. RESULTS: The database contains 222 patients, of which 85 subjects were managed with HFOV. Of this HFOV cohort, the overall pediatric ICU survival was 23.5% (n = 20). HFOV survivors were transitioned to HFOV at a lower oxygenation index than nonsurvivors (25.6, interquartile range 21.1-36.8, vs 37.2, interquartile range 26.5-52.2, P = .046). Survivors were transitioned to HFOV earlier in the course of mechanical ventilation, (day 0 vs day 2, P = .002). No subject survived who was transitioned to HFOV after 1 week of invasive mechanical ventilation. We compared subjects with severe pediatric ARDS treated only with conventional mechanical ventilation versus early HFOV (within 2 d of invasive mechanical ventilation) versus late HFOV. There was a trend toward difference in survival (conventional mechanical ventilation 24%, early HFOV 30%, and late HFOV 9%, P = .08). CONCLUSIONS: In this large database of pediatric allogeneic hematopoietic cell transplant subjects who had acute respiratory failure requiring invasive mechanical ventilation for critical illness with severe pediatric ARDS, early use of HFOV was associated with improved survival compared to late implementation of HFOV, and the subjects had outcomes similar to those treated only with conventional mechanical ventilation.
INTRODUCTION: The effectiveness of high-frequency oscillatory ventilation (HFOV) in the pediatric hematopoietic cell transplant patient has not been established. We sought to identify current practice patterns of HFOV, investigate parameters during HFOV and their association with mortality, and compare the use of HFOV to conventional mechanical ventilation in severe pediatric ARDS. METHODS: This is a retrospective analysis of a multi-center database of pediatric and young adult allogeneic hematopoietic cell transplant subjects requiring invasive mechanical ventilation for critical illness from 2009 through 2014. Twelve United States pediatric centers contributed data. Continuous variables were compared using a Wilcoxon rank-sum test or a Kruskal-Wallis analysis. For categorical variables, univariate analysis with logistic regression was performed. RESULTS: The database contains 222 patients, of which 85 subjects were managed with HFOV. Of this HFOV cohort, the overall pediatric ICU survival was 23.5% (n = 20). HFOV survivors were transitioned to HFOV at a lower oxygenation index than nonsurvivors (25.6, interquartile range 21.1-36.8, vs 37.2, interquartile range 26.5-52.2, P = .046). Survivors were transitioned to HFOV earlier in the course of mechanical ventilation, (day 0 vs day 2, P = .002). No subject survived who was transitioned to HFOV after 1 week of invasive mechanical ventilation. We compared subjects with severe pediatric ARDS treated only with conventional mechanical ventilation versus early HFOV (within 2 d of invasive mechanical ventilation) versus late HFOV. There was a trend toward difference in survival (conventional mechanical ventilation 24%, early HFOV 30%, and late HFOV 9%, P = .08). CONCLUSIONS: In this large database of pediatric allogeneic hematopoietic cell transplant subjects who had acute respiratory failure requiring invasive mechanical ventilation for critical illness with severe pediatric ARDS, early use of HFOV was associated with improved survival compared to late implementation of HFOV, and the subjects had outcomes similar to those treated only with conventional mechanical ventilation.
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