The Experience of High Frequency Oscillatory Ventilation in Children with Respiratory Failure / 소아알레르기및호흡기학회지

ABSTRACT

PURPOSE: High frequency oscillatory ventillation (HFOV) is an alternative to conventional ventilation (CV) when oxygenation deteriorates. This study evaluates the efficacy and safety of HFOV in children with respiratory failure. METHODS: Ten cases with respiratory failure (age 8.7+/-7.6 mo, body weight 6.8+/-2.6 kg) that underwent HFOV for more than 3 days because of failure of oxygenation by CV were enrolled. PaO2/FiO2, oxygenation index (OI), (A-a) DO2, mean airway pressure (MAP), blood pressure, heart rate, PEediatric Logistic Organ Dysfunction (PELOD) score and complications were evaluated before and at 6, 12, 24, 48, 72 hours of HFOV. The influencing factors were compared between an HFOV success group and a failure group, and outcomes were evaluated. RESULTS: 1) Lower FiO2 was required for proper oxygenation by HFOV, although MAP was significantly increased. (P< 0.05) 2) PaO2/FiO2 was higher (P=0.002) and (A-a) DO2 was lower than baseline (P< 0.001) during HFOV. However, no significant difference was observed for OI, PaO2, PaCO2 or pH. 3) In the HFOV success group, (A-a) DO2 was significantly lower than failure group at baseline, (P=0.045) and OI was also significantly lower than in the failure group at 6 hours of HFOV. (P=0.032) PaO2/FiO2 was significantly improved in the success group at 6 hours of HFOV. (P=0.045) 4) Complications were air leak, 20% (2/10), and hypotension, 40% (4/10), which was corrected by using inotropics. PELOD scores decreased in all patients compared to at baseline throughout HFOV. (P=0.03) 5) Sixty percent patients survived for 3 months after HFOV were 60% (6/10). The success of HFOV related to survival. (P=0.048) CONCLUSION: HFOV can be used to improve oxygenation effectively and safely in children with respiratory failure who did not improve with CV.