HFO is Efficient in Pediatric ARDS

Overview

Objective:
There were two primary outcome measures of the study: 1. To demonstrate the effect of high frequency oscillation on gas exchange inchildren with severe respiratory failure (ARDS) in whom conventional ventilation failed. 2. To try to identify patients in whom high frequency oscillationis highly suspicious to fail, bearing a high risk of subsequent death.Study design: Retrospective analysis of the set of patients.Setting: Department of Anesthesiology and Intensive Care; ECMO Center University Children Hospital Brno.Patients: 26 patients > 1 month of age with severe hypoxemic respiratory failure and ARDS. Mean age was 3.66 years (three adult patients O 17,19 and 24 years), maximum weight 70 kilograms, 17 boys, 9 girls. 15 patients died. 84.6% per cent of patients suffered from basic medical disease,mean admission PRISM score was 22. Nine patients met ECMO criteria. In two of them ECMO was not necessary, in 5 ECMO was contraindicated,two patients were treated with ECMO. Four patients ventilated in HFO mode were also treated with NO, in two of them partial liquid ventilation wasalso implemented.Methods: Patients were ventilated in PCV or PRVC modes with limited peak inspiratory pressures and permissive hypercapnia. Tracheal gasinsufflation was instituted if paCO2 > 10,0 kPa and/or pH 0.6 and Paw > 15 cmH2O tomaintain peripheral blood saturation > 90% or due to persistent hypercapnia and/or acidosis with CMV with TGI. HFO was designed as —High VolumeStrategyii to recruit the alveoli and keep the optimal lung volume. Before switching back to CMV, following criteria had to be met: Paw 15O20 cmH2O,FiO2 90%, FiO2

Key words:
HFO O respiratory failure O children O conventional mechanical ventilation