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2007, Number 2

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Med Crit 2007; 21 (2)

High frequency oscillatory ventilation in the rescue of children on acute respiratory failure with catastrophic hypoxemia

Cruces RP, Donoso FA, León BJ, Valenzuela VJ, Camacho ÁJ

Language: Spanish
References: 37
Page: 67-73
PDF size: 77.50 Kb.


ABSTRACT

Introduction: High frequency oscillatory ventilation (HFOV) is a ventilatory modality which has demonstrated to be useful in patients with ARDS refractory to conventional mechanical ventilation (CMV). The role of this therapy on catastrophic hypoxemia (oxygenation index [OI] over 40) is not clearly defined yet since these patients are suitable for ECMO therapy nowadays.
Objective: To report the effect of HFOV in severe ARDS refractory to maximal CMV therapy. b>Design and patients: A Sensor Medics 3100A ventilator was used. We considered all the patients who were admitted between 1999 and 2005 for global acute respiratory failure who remained with OI over 40 despite maximal CMV. The record included arterial blood gases immediately before and during the first 48 hours of HFOV, and prior to the switch onto CMV. We analyzed the duration on HFOV, the presence of complications and the mortality rate of the group.
Measurements and results: Twelve patients were enrolled with a median age of 3.5 months, and lung injury score of 3.5 (range: 3.25 to 4). Prior to HFOV the median PaO2/FIO2 ratio and OI were 39 and 47, respectively. The previous CMV duration was 65 hours. The therapy was extremely useful in improving the oxygenation obtaining the maximal effect at the 24 hours of therapy (PaO2/FIO2 ratio = 137 e IO = 18, p ‹ 0.01). The survival rate was 75% on day 28.
Conclusions: A reasonably high survival rate associated with an improvement of the oxygenation is achieved in patients with extreme hypoxemia using HFOV. Thus, this therapy should be considered in this group.


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