Uso de ventilación de alta frecuencia oscilatoria en pacientes pediátricos

Abstract

Background : The goal of ventilatory management in patients with acute respiratory distress syndrome (ARDS) is alveolar recruitment and maintenance of lung volume. High frequency oscillatory ventilation (HFOV) produces very small tidal volumes with rapid respiratory rates, reducing peak inspiratory pressure and the risk of volutrauma. Aim : To present our experience of HFOV in a paedriatric ICU. Patients and Methods : Patients less than 16 years with acute respiratory failure (PaO 2 /FiO 2 16) refractory to conventional mechanical ventilation were included. A prospective observational study shows the clinical features, ventilatory settings and the response of oxygenation. Results : 29 patients had 31 HFO ventilations, 90% with ARDS. Patients had a median age of 5 months (range 1-104 months) and a weight of 6 kg (3.2-60 kg). Prior conventional ventilation had a median duration of 33 hrs (0-740). OI at the beginning of HFOV was 27. Mean airway pressure was initially set at 10 cm H2O above the conventional ventilation value. Mean duration on HFOV was 85 hrs. All patients presented a decrease in the OI during the first 48 hrs; no statistical difference between survivors and non-survivors was found. The most frequent side effect was transient hypotension. Ten patients died, a pulmonary cause in 7 with a specific lethality of 24% (7/29). Conclusions : If certain conditions are met, HFOV appears to be an effective mode of ventilation in paedriatric respiratory failure refractory to conventional ventilation.