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Feasibility of an alternative, physiologic, individualized open-lung approach to high-frequency oscillatory ventilation in children.

Abstract：

BACKGROUND:High-frequency oscillatory ventilation (HFOV) is a common but unproven management strategy in paediatric critical care. Oscillator settings have been traditionally guided by patient age and/or weight rather than by lung mechanics, thereby potentially negating any beneficial effects. We have adopted an open-lung HFOV strategy based on a corner frequency approach using an initial incremental-decremental mean airway pressure titration manoeuvre, a high frequency (8-15 Hz), and high power to initially target a proximal pressure amplitude (∆Pproximal) of 70-90 cm H2O, irrespective of age or weight. METHODS:We reviewed prospectively collected data on patients < 18 years of age who were managed with HFOV for acute respiratory failure. We measured metrics for oxygenation, ventilation, and haemodynamics as well as the use of sedative-analgesic medications and neuromuscular blocking agents. RESULTS:Data from 115 non-cardiac patients were analysed, of whom 53 had moderate-to-severe paediatric acute respiratory distress syndrome (PARDS). Sixteen patients (13.9%) died. Frequencies≥ 8 Hz and high ∆Pproximal were achieved in all patients irrespective of age or PARDS severity. Patients with severe PARDS showed the greatest improvement in oxygenation. pH and PaCO2 normalized in all patients. Haemodynamic parameters, cumulative amount of fluid challenges, and daily fluid balance did not deteriorate after transitioning to HFOV in any age or PARDS severity group. We observed a transient increase neuromuscular blocking agent use after switching to HFOV, but there was no increase in the daily cumulative amount of continuous midazolam or morphine in any age or PARDS severity group. No patients experienced clinically apparent barotrauma. CONCLUSIONS:This is the first study reporting the feasibility of an alternative, individualized, physiology-based open-lung HFOV strategy targeting high F and high ∆Pproximal. No adverse effects were observed with this strategy. Our findings warrant further systematic evaluation.

journal_name

Ann Intensive Care

journal_title

Annals of intensive care

authors

de Jager P,Kamp T,Dijkstra SK,Burgerhof JGM,Markhorst DG,Curley MAQ,Cheifetz IM,Kneyber MCJ

doi

10.1186/s13613-019-0492-0

subject

Has Abstract

pub_date

2019-01-18 00:00:00

pages

issue

issn

2110-5820

pii

10.1186/s13613-019-0492-0

journal_volume

pub_type

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Feasibility of an alternative, physiologic, individualized open-lung approach to high-frequency oscillatory ventilation in children.