Ventilación de alta frecuencia oscilatoria en pacientes pediátricos

Introduction: High-frequency oscillatory ventilation (HFOV) uses small tidal volumes, often smaller than the anatomic dead space, with high respiratory rates (> 1 Hz). This therapeutic option has become more popular in our country in the last years. Study objectives: To review the clinical experience with HFOV in our Pediatric Intensive Care Unit and to describe the patient's characteristics, HFOV strategies and outcome. Patients: A prospective study included patients less than 16 years old with Acute Respiratory Distress Syndrome (ARDS) refractary to conventional mechanical ventilation (CMV). We compare two periods (1999-2001 and 2002-2004). Measurements and results: Forty-nine patients underwent onto 51 episodes of HFO ventilation, 80% presented with primary ARDS. Previous conventional ventilation was 47 hours long. The median value of the oxygenation index (OI) at the beginning of HFOV was 24. Mean airway pressure was initially set at 9 cmH ₂O above the value in conventional ventilation. All the patients presented a decrease of their OI and ventilation was improved during the first 48 hours of therapy. Median duration on HFOV was 102 hours. The most frequent side effect was transient hypotension (25%). In the second period we observed a decrease in hemodynamic complications and also an increase in HFO duration. The mortality rate was 33% (22% due to pulmonary cause). Conclusion: HFOV is an effective therapy for pediatric respiratory failure refractory to conventional mechanical ventilation.