Download PDF
J Pediatr Intensive Care 2016; 05(01): 012-020
DOI: 10.1055/s-0035-1568160
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Use of High-Frequency Ventilation in the Pediatric Intensive Care Unit

Daniel S. Tawfik
1   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Tellen D. Bennett
2   Department of Pediatric Critical Care, Children's Hospital Colorado, Aurora, Colorado, United States
3   Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Brent Welch
4   Department of Respiratory Care Services, Primary Children's Hospital, Salt Lake City, Utah, United States
,
W. Bradley Poss
1   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
5   Department of Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, United States
› Author Affiliations
Further Information

Publication History

24 February 2015

24 June 2015

Publication Date:
30 November 2015 (online)

    Permissions and Reprints

Abstract

Objective To evaluate the clinical characteristics, ventilator settings, and gas exchange indices of patients placed on high-frequency percussive ventilation (HFPV) and high-frequency oscillatory ventilation (HFOV).

Methods Retrospective observation of all consecutive patients aged 0 to 18 years with acute respiratory failure managed with high-frequency ventilation from the institution's introduction of HFPV on May 1, 2012, until July 10, 2013.

Measurements and Main Results Twenty-seven patients underwent HFPV as a first mode of high-frequency ventilation and 16 patients underwent HFOV first. HFPV was used more frequently in patients with acute respiratory illnesses (p < 0.01), lower Pediatric Index of Mortality 2 scores (rank-sum p < 0.04), higher Spo 2/Fio 2 (SF) ratios (p < 0.01), and lower oxygen saturation indices (p < 0.01). HFPV patients showed increased SF ratios (p < 0.01) and decreased Paco 2 levels (p = 0.02) 6 hours after initiation, and HFOV patients showed no significant differences. Peak inspiratory pressures (HFPV) and mean airway pressures (HFOV) remained at or below 30 cm H2O at each time point. HFPV and HFOV patients had an average of 2.8 and 2.9 mode changes, respectively. Mortality was 15% in the HFPV group and 50% in the HFOV group.

Conclusions HFPV is associated with rapid improvement in oxygenation and ventilation at acceptable airway pressures in patients with acute respiratory failure of various etiologies, primarily for those with difficulties of ventilation or secretion management. In our institution, HFOV appears to be initiated first in children with higher severity of illness.

Keywords

acute lung injury - acute respiratory failure - high-frequency percussive ventilation - high-frequency oscillatory ventilation - high-frequency ventilation
 

  • References

  • 1 Nitu ME, Eigen H. Respiratory failure. Pediatr Rev 2009; 30 (12) 470-477 , quiz 478
    CrossrefPubMedGoogle Scholar
  • 2 Randolph AG, Meert KL, O'Neil ME , et al; Pediatric Acute Lung Injury and Sepsis Investigators Network. The feasibility of conducting clinical trials in infants and children with acute respiratory failure. Am J Respir Crit Care Med 2003; 167 (10) 1334-1340
    CrossrefPubMedGoogle Scholar
  • 3 Kacmarek RM. The mechanical ventilator: past, present, and future. Respir Care 2011; 56 (8) 1170-1180
    CrossrefPubMedGoogle Scholar
  • 4 The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342 (18) 1301-1308
    CrossrefPubMedGoogle Scholar
  • 5 Amato MB, Barbas CS, Medeiros DM , et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338 (6) 347-354
    CrossrefPubMedGoogle Scholar
  • 6 Salim A, Martin M. High-frequency percussive ventilation. Crit Care Med 2005; 33 (3, Suppl): S241-S245
    CrossrefPubMedGoogle Scholar
  • 7 Krishnan JA, Brower RG. High-frequency ventilation for acute lung injury and ARDS. Chest 2000; 118 (3) 795-807
    CrossrefPubMedGoogle Scholar
  • 8 Habashi NM. Other approaches to open-lung ventilation: airway pressure release ventilation. Crit Care Med 2005; 33 (3, Suppl): S228-S240
    Google Scholar
  • 9 Thomas NJ, Jouvet P, Willson D. Acute lung injury in children—kids really aren't just “little adults”. Pediatr Crit Care Med 2013; 14 (4) 429-432
    CrossrefPubMedGoogle Scholar
  • 10 Imai Y, Slutsky AS. High-frequency oscillatory ventilation and ventilator-induced lung injury. Crit Care Med 2005; 33 (3, Suppl): S129-S134
    CrossrefPubMedGoogle Scholar
  • 11 Kneyber MCJ, van Heerde M, Markhorst DG. Reflections on pediatric high-frequency oscillatory ventilation from a physiologic perspective. Respir Care 2012; 57 (9) 1496-1504
    CrossrefPubMedGoogle Scholar
  • 12 Arnold JH, Anas NG, Luckett P , et al. High-frequency oscillatory ventilation in pediatric respiratory failure: a multicenter experience. Crit Care Med 2000; 28 (12) 3913-3919
    CrossrefPubMedGoogle Scholar
  • 13 Ben Jaballah N, Khaldi A, Mnif K , et al. High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure. Pediatr Crit Care Med 2006; 7 (4) 362-367
    CrossrefPubMedGoogle Scholar
  • 14 Bird FM. Volumetric Diffusive Respiration Operations Manual F-110804. Sandpoint, Idaho: Percussionaire Corporation; 1989
    Google Scholar
  • 15 Cioffi Jr WG, Rue III LW, Graves TA, McManus WF, Mason Jr AD, Pruitt Jr BA. Prophylactic use of high-frequency percussive ventilation in patients with inhalation injury. Ann Surg 1991; 213 (6) 575-580 , discussion 580–582
    CrossrefPubMedGoogle Scholar
  • 16 Hall JJ, Hunt JL, Arnoldo BD, Purdue GF. Use of high-frequency percussive ventilation in inhalation injuries. J Burn Care Res 2007; 28 (3) 396-400
    CrossrefPubMedGoogle Scholar
  • 17 Cortiella J, Mlcak R, Herndon D. High frequency percussive ventilation in pediatric patients with inhalation injury. J Burn Care Rehabil 1999; 20 (3) 232-235
    CrossrefPubMedGoogle Scholar
  • 18 Blarent D, Steppe M, Muller F , et al. High-frequency jet percussive ventilation in newborns and infants with damaged lungs. Acta Anaesthesiol Belg 1985; 3: 127-128
    PubMedGoogle Scholar
  • 19 Pfenninger J, Gerber AC. High-frequency ventilation (HFV) in hyaline membrane disease—a preliminary report. Intensive Care Med 1987; 13 (1) 71-75
    CrossrefPubMedGoogle Scholar
  • 20 Paulsen SM, Killyon GW, Barillo DJ. High-frequency percussive ventilation as a salvage modality in adult respiratory distress syndrome: a preliminary study. Am Surg 2002; 68 (10) 852-856 , discussion 856
    PubMedGoogle Scholar
  • 21 Velmahos GC, Chan LS, Tatevossian R , et al. High-frequency percussive ventilation improves oxygenation in patients with ARDS. Chest 1999; 116 (2) 440-446
    CrossrefPubMedGoogle Scholar
  • 22 Gallagher TJ, Boysen PG, Davidson DD, Miller JR, Leven SB. High-frequency percussive ventilation compared with conventional mechanical ventilation. Crit Care Med 1989; 17 (4) 364-366
    CrossrefPubMedGoogle Scholar
  • 23 Mabe TG, Honeycutt T, Cairns BA, Kocis KC, Short KA. High-frequency percussive ventilation in a pediatric patient with hydrocarbon aspiration. Pediatr Crit Care Med 2007; 8 (4) 383-385
    CrossrefPubMedGoogle Scholar
  • 24 Rizkalla NA, Dominick CL, Fitzgerald JC, Thomas NJ, Yehya N. High-frequency percussive ventilation improves oxygenation and ventilation in pediatric patients with acute respiratory failure. J Crit Care 2014; 29 (2) 314.e1-314.e7
    CrossrefPubMedGoogle Scholar
  • 25 Slater A, Shann F, Pearson G ; Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29 (2) 278-285
    CrossrefPubMedGoogle Scholar
  • 26 Khemani RG, Thomas NJ, Venkatachalam V , et al; Pediatric Acute Lung Injury and Sepsis Network Investigators (PALISI). Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit Care Med 2012; 40 (4) 1309-1316
    CrossrefPubMedGoogle Scholar
  • 27 Chung KK, Wolf SE, Renz EM , et al. High-frequency percussive ventilation and low tidal volume ventilation in burns: a randomized controlled trial. Crit Care Med 2010; 38 (10) 1970-1977
    CrossrefPubMedGoogle Scholar
  • 28 Hurst JM, Branson RD, Davis Jr K, Barrette RR, Adams KS. Comparison of conventional mechanical ventilation and high-frequency ventilation. A prospective, randomized trial in patients with respiratory failure. Ann Surg 1990; 211 (4) 486-491
    CrossrefPubMedGoogle Scholar
  • 29 Young D, Lamb SE, Shah S , et al; OSCAR Study Group. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med 2013; 368 (9) 806-813
    CrossrefPubMedGoogle Scholar
  • 30 Ferguson ND, Cook DJ, Guyatt GH , et al; OSCILLATE Trial Investigators; Canadian Critical Care Trials Group. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 2013; 368 (9) 795-805
    CrossrefPubMedGoogle Scholar