High-frequency oscillatory ventilation for acute respiratory distress syndrome

To evaluate the effectiveness of HFOV in pediatric patients with acute respiratory distress syndrome. In this retrospective study, we reviewed all 20 pediatric patients, who were consecutively ventilated with HFOV in the pediatric intensive care unit of a tertiary medical center, from January 2006 to February 2007. A total of 20 patients were enrolled. The median age of the subjects was 70 (3-168) months; 10 were male. All patients received conventional ventilation before HFOV. After initiation of HFOV, there was an immediate and sustained increase in PaO2/FiO(2) ratio. The PaO2/FiO(2) ratio was elevated and OI was decreased significantly after 10-20 minutes and maintained for at least 48 hours (p= 0.03, both). Thirteen of the 20 patients were successfully weaned. No significant change in the mean arterial pressure and heart rate was noted after HFOV. Overall survival rate was 65%. Of 20 patients, 11 patients suffered from extrapulmonary ARDS (ARDSexp) and 9 from pulmonary ARDS (ARDSp). When HFOV was initiated, there was significant increase in PaO2/FiO(2) and decrease in OI in ARDSexp compared to ARDSp (p= 0.03, both). Also mortality rate was significantly lower in patients with ARDSexp (9% vs.66%), (p= 0.01). In our study, HFOV was effective in oxygenation and seems to be safe for pediatric ARDS patients. HFOV affected ARDSp and ARDSexp paediatric patients differently. However prospective, randomized controlled trials are needed to identify its benefits over conventional modes of mechanical ventilation.