High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure

Pediatr Crit Care Med. 2006 Jul;7(4):362-7. doi: 10.1097/01.PCC.0000227108.38119.2E.


Objective: To evaluate the effectiveness of high-frequency oscillatory ventilation (HFOV) in pediatric patients with acute respiratory failure, failing conventional ventilation.

Design: A prospective, clinical study.

Setting: Tertiary care pediatric intensive care unit.

Patients: Twenty pediatric patients (ages 12 days to 5 yrs) with acute respiratory failure (pneumonia, 14; sepsis with acute respiratory distress syndrome, 3; pulmonary edema as a complication of upper airway obstruction, 2; salicylate intoxication with acute respiratory distress syndrome, 1), failing conventional ventilation (median alveolar-arterial oxygen difference [P(A-a)O2] 578 [489-624] torr, median oxygenation index 26 [21-32].

Interventions: HFOV was instituted after a median length of conventional ventilation of 15.5 (3.3-43.5) hrs.

Measurements and main results: Ventilator settings, arterial blood gases, oxygenation index, and P(A-a)O2 were recorded before HFOV (0 hrs) and at predetermined intervals during HFOV and compared using the one-way Friedman rank-sum procedure and a two-tailed Wilcoxon matched-pairs test. Initiation of HFOV caused a significant decrease in FiO2 at 1 hr that continued to 24 hrs (p <or= .04). In all patients, target ventilation was achieved, and 19 had improved oxygenation. After 1 hr, PaCO2 significantly decreased (p = .002) and remained within the target range thereafter. There were significant decreases in P(A-a)O2 and oxygenation index at 1 and 4 hrs, respectively, that were sustained up to 12 hrs (p <or= .04). No significant complications associated with HFOV were detected. Fifteen patients (75%) survived to hospital discharge. Only one patient died from respiratory failure.

Conclusions: In pediatric patients with acute respiratory failure, failing conventional ventilation, HFOV improves gas exchange in a rapid and sustained fashion. However, randomized controlled trials are needed to identify its benefits over conventional modes of mechanical ventilation.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Disease
  • Child, Preschool
  • Female
  • High-Frequency Ventilation*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Prospective Studies
  • Pulmonary Gas Exchange
  • Respiratory Distress Syndrome / therapy
  • Respiratory Insufficiency / therapy*
  • Survival Analysis