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Vol. 89. Issue 1.
Pages 48-55 (January - February 2013)
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Vol. 89. Issue 1.
Pages 48-55 (January - February 2013)
Original article
Open Access
High-frequency Oscillatory Ventilation in Children: A 10-year Experience
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Marta Moniza,
Corresponding author
marta.moniz@gmail.com

Corresponding author.
, Catarina Silvestreb, Pedro Nunesb, Clara Abadessob, Ester Matiasb, Helena Loureirob, Helena Almeidac
a Fellow Pediatrician, Pediatric Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
b MD. Pediatric Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
c MD. Chief, Pediatric Intensive Care Unit of Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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Article information
Abstract
Objectives

The aim of the study was to describe the experience with high-frequency oscillatory ventilation (HFOV) in a Portuguese Pediatric Critical Care Unit, and to evaluate whether HFOV allowed improvement in oxygenation and ventilation.

Methods

This was a retrospective observational cohort study of children ventilated by HFOV between January, 2002 and December, 2011. The following parameters were recorded: demographic and clinical data, and blood gases and ventilatory parameters during the first 48hours of HFOV.

Results

80 children were included, with a median age of 1.5 months (min: one week; max: 36 months). Pneumonia (n=50; 62.5%) and bronchiolitis (n=18; 22.5%) were the main diagnoses. Approximately 40% (n=32) of the patients developed acute respiratory distress syndrome (ARDS). Conventional mechanical ventilation was used in 68 (85%) of patients prior to HFOV. All patients who started HFOV had hypoxemia, and 56 (70%) also presented persistent hypercapnia. Two hours after starting HFOV, a significant improvement in SatO2/FiO2 ratio (128±0.63 vs. 163±0.72; p<0.001) that was sustained up to 24hours of HFOV and a decrease in FiO2 were observed. Since the beginning of HFOV, the mean PCO2 significantly decreased (87±33 vs. 66±25; p<0.001), and the pH significantly improved (7.21±0.17 vs. 7.32±0.15; p<0.001). Overall survival was 83.8%.

Conclusions

HFOV enabled an improvement in hypercapnia and oxygenation. It is a safe option for the treatment of ARDS and severe small airway diseases.

Keywords:
High frequency oscillatory ventilation
Child
Acute respiratory failure
Bronchiolitis
Pneumonia
Acute respiratory distress syndrome
Resumo
Objetivos

O objetivo do estudo foi descrever a experiência com ventilação oscilatória de frequência (VOAF) em uma unidade portuguesa de Cuidados Intensivos Neonatais e Pediátricos e avaliar se a VOAF permitiu uma melhoria na oxigenação e na ventilação.

Métodos

Estudo de coorte retrospectivo observacional em crianças submetidas À ven- tilação com VOAF entre janeiro de 2002 e dezembro de 2011. Os seguintes parâmetros foram registrados: dados demográficos e clínicos; gases sanguíneos; e parâmetros venti- latórios durante as primeiras 48 horas de VOAF.

Resultados

O estudo incluiu 80 crianças com uma idade média de 1,5 mês (mínima: uma semana; máxima: 36 meses). Pneumonia (n=50; 62,5%) e bronquiolite (n=18; 22,5%) foram os principais diagnósticos. Cerca de 40% (n=32) dos pacientes desenvolveram a síndrome da angústia respiratória aguda (SARA). A ventilação mecânica convencional foi utilizada em 68 (85%) pacientes antes da VOAF. Todos os pacientes que começaram a VOAF tiveram hipoxemia, e 56 (70%) também apresentaram hipercapnia persistente. Duas horas após o início da VOAF, foi observada uma melhoria significativa na proporção SatO2/FiO2 (128±0,63 em comparação a 163±0,72; p<0,001), que foi mantida durante as 24 horas de VOAF, e uma redução da FiO. Desde o início da VOAF, a PCO2 média teve uma queda significativa (87±33 em comparação a 66±25; p<0,001) e o pH aumentou significativamente (7,21±0,17 em comparação a 7,32±0,15; p<0,001). A sobrevida geral foi de 83,8%.

Conclusões

A VOAF permitiu uma melhoria na hipercapnia e na oxigenação. Trata-se de uma opção segura no tratamento da SARA e de doenças graves das pequenas vias aéreas.

Palavras-chave:
Ventilação oscilatória de alta frequência
Criança
Insuficiência respiratória aguda
Bronquiolite
Pneumonia
Síndrome da angústia respiratória aguda
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Please, cite this article as: Moniz M, Silvestre C, Nunes P, Abadesso C, Matias E, Loureiro H, et al. High-frequency oscillatory ventilation in children: a 10-year experience.J Pediatr (Rio J). 2013;89:48-55.

Copyright © 2013. Sociedade Brasileira de Pediatria
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