Análisis de efectividad de la ventilación de alta frecuencia oscilatoria en pacientes pediátricos con insuficiencia respiratoria aguda en un centro de alta complejidad

Abstract

Introduction. High frequency oscillatory ventilation (HFOV) is a rescue therapy for hypoxemic patients who deteriorate in conventional mechanical ventilation and/or for the air-leak syndrome treatment. A recent meta analysis showed that HFOV might have reduced mortality in pediatric and adult patients compared with conventional ventilation. In this context it's important to evaluate the effectiveness of this method in everyday use. Objectives. Main: To analize the effectiveness of HFOV in everyday practice in a center without extra corporeal membrane oxygenation (ECMO) capabilities. Secondary: To describe demographics and causes of severe respiratory failure of patients requiring HFOV. To assess the relationship between potential predictors and the occurrence of mortality. Population and methods. Retrospective study analyzing medical records of all patients that required HFOV in a tertiary care pediatric hospital pediatric intensive care units between march 1st 2008 and july 1st 2010. Results. Sixty-nine patients received 76 HFOV treatments. Eighty percent were diagnosed with acute lower respiratory infection or sepsis and 62.3% (n= 43) had preexisting chronic co-morbidities. The majority of HFOV treatments were because refractory hypoxemia (93.4%). Non survivors patients had worse clinical status at PICU admission, higher multiorgan failure, worse oxygenation and pulmonary condition. Conclusions. Everyday use of HFOV in a population with high incidence of chronic, oncologic and/or immunocompromised patients was associated with a survival of 33.4%. More prognostic studies are needed for a more effective selection of HFOV candidates.