High Frequency Oscillatory Ventilation for Respiratory Failure Due to RSV Bronchiolitis

Intensive Care Med. 2008 Sep;34(9):1698-702. doi: 10.1007/s00134-008-1151-3. Epub 2008 May 24.

Abstract

Objective: To describe the time course of high frequency oscillatory ventilation (HFOV) in respiratory syncytial virus (RSV) bronchiolitis.

Design: Retrospective charts review.

Setting: A tertiary paediatric intensive care unit.

Patients and participants: Infants with respiratory failure due to RSV infection.

Intervention: HFOV.

Measurements and results: Pattern of lung disease, ventilatory settings, blood gases, infant's vital parameters, sedation and analgesia during the periods of conventional mechanical ventilation (CMV, 6 infants), after initiation of HFOV (HFOVi, 9 infants), in the middle of its course (HFOVm), at the end (HFOVe) and after extubation (Post-Extub) were compared. All infants showed a predominant overexpanded lung pattern. Mean airway pressure was raised from a mean (SD) 12.5 (2.0) during CMV to 18.9 (2.7) cmH(2)O during HFOVi (P < 0.05), then decreased to 11.1(1.3) at HFOVe (P < 0.05). Mean FiO(2) was reduced from 0.68 (0.18) (CMV) to 0.59 (0.14) (HFOVi) then to 0.29 (0.06) (P < 0.05) at HFOVe and mean peak to peak pressure from 44.9 (12.4) cmH(2)O (HFOVi) to 21.1 (7.7) P < 0.05 (HFOVe) while mean (SD) PaCO(2) showed a trend to decrease from 72 (22) (CMV) to 47 (8) mmHg (HFVOe) and mean infants respiratory rate a trend to increase from 20 (11) (HFOVi) to 34 (14) (HFOVe) breaths/min. With usual doses of sedatives and opiates, no infant was paralysed and all were extubated to CPAP or supplemental oxygen after a mean of 120 h.

Conclusion: RSV induced respiratory failure with hypercapnia can be managed with HFOV using high mean airway pressure and large pressure swings while preserving spontaneous breathing.

MeSH terms

  • Blood Pressure
  • Bronchiolitis, Viral / therapy*
  • High-Frequency Ventilation / methods*
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric
  • Medical Records
  • Respiratory Syncytial Virus Infections / therapy*
  • Respiratory Syncytial Virus, Human*
  • Retrospective Studies