Faculty Collaboration Database

Predicting outcome in children with severe acute respiratory failure treated with high-frequency ventilation. Crit Care Med 1996 Aug;24(8):1396-402

Date

08/01/1996

Pubmed ID

8706497

DOI

10.1097/00003246-199608000-00020

Scopus ID

2-s2.0-0029838134 (requires institutional sign-in at Scopus site)   65 Citations

Abstract

OBJECTIVES: a) To demonstrate the effect of high-frequency ventilation on gas exchange in children with severe acute respiratory failure unresponsive to conventional ventilation; b) to identify patients at high risk of death early after institution of high-frequency ventilation.

SETTING: Tertiary care pediatric intensive care unit in a university hospital.

DESIGN: A cross-sectional, observational study with factorial design.

PATIENTS: Thirty-one patients with severe acute respiratory failure defined as a Pao2/F1o2 of < 150 torr (< 20 kPa) with a positive end-expiratory pressure of > or = 8 cm H2O and/or Paco2 of > 60 torr (> 8 kPa) with an arterial pH < 7.25.

INTERVENTIONS: Patients received either high-frequency oscillation or jet ventilation if respiratory failure was unresponsive to conventional ventilation and if the underlying disease process was deemed reversible.

MEASUREMENTS AND MAIN RESULTS: Thirty-one children were managed with high-frequency ventilation, 11 children with jet and 20 children with oscillator. Arterial blood gases and level of ventilatory support were recorded before and at 6, 24, 48, 72, and 96 hrs after institution of high-frequency ventilation. There was an improvement in an arterial pH, Paco2, Pao2, and Pao2/FID2 6 hrs after institution of high-frequency ventilation (p < .01). This improvement, along with decreased need for oxygen, was sustained through the subsequent course. Twenty-three (74%) of 31 children treated with high-frequency ventilation survived. Survivors showed an increase in an arterial pH, Pao2, Pao2/FIO2, and a decrease in Paco2 within 6 hrs, whereas nonsurvivors did not. Oxygenation index was the best predictor of outcome. A combination of an initial oxygenation index of > 20 and failure to decrease the oxygenation index by > 20% by 6 hrs after initiation of high-frequency ventilation predicted death with 88% (7/8) sensitivity and 83% (19/23) specificity, with an odds ratio of 33 (p = .0036, 95% confidence interval 3-365).

CONCLUSIONS: In patients with potentially reversible underlying diseases resulting in severe acute respiratory failure that is unresponsive to conventional ventilation, high-frequency ventilation improves gas exchange in a rapid and sustained fashion. The magnitude of impaired oxygenation and its improvement after high-frequency ventilation can predict outcome within 6 hrs.

Author List

Sarnaik AP, Meert KL, Pappas MD, Simpson PM, Lieh-Lai MW, Heidemann SM

Author

Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Child
Critical Care
Cross-Sectional Studies
High-Frequency Ventilation
Humans
Intensive Care Units, Pediatric
Logistic Models
Predictive Value of Tests
Respiratory Insufficiency
Risk Factors
Statistics, Nonparametric
Survival Rate
Treatment Outcome