The Science Journal of the American Association for Respiratory Care

1995 OPEN FORUM Abstracts

HIGH-FREQUENCY OSCILLATORY VENTILATION IN PEDIATRICS; A REVIEW OF APPLICATION AND MANAGEMENT PRACTICE

Lauren Perlman RRT, Peter Betit RRT, John H. Arnold MD Departments of Respiratory Care and Anesthesia, Children's Hospital and Harvard Medical School, Boston MA.

The application of high-frequency oscillatory ventilation (HFOV) in pediatric patients has recently increased. Published data with respect to HFOV settings and management are limited in this population. We reviewed the use of HFOV (SensorMedics 3100/3100A, Yorba Linda, CA) in our pediatric ICU in order to identify trends in management strategies. HFOV data was retrospectively reviewed from 1/1/94 to 5/1/95. Data included age, diagnosis (Dx), weight, frequency (FREQ), maximum power setting (MPS) with corresponding PaCO_2, and P_{aw} at one and 24 Hrs with corresponding F_iO_2 and PaO_2. The P_{aw} requirement on conventional ventilation (CV) was compared to the one Hr HFOV P_{aw}. Forty-four patients, ages two months to 28 years, were evaluated. Five were excluded from the 24 Hr data (3 expired, 1 placed on ECMO and 1 HFOV was discontinued). Groups by Dx were: ARDS(n=19), infectious pneumonia(n=14), RSV(n=6) and other(n=5). Four weight groups were established, A:2.5-10kg, B:11-20kg, C:21-40kg and D:41-60kg.

Results (mean±SD)A (2.5-10Kg.) B (11-20Kg.) C (21-40Kg) D (41-60Kg.)

Frequency (hz)12±2.28±0.9 7±1.26±0.7

MPS 4.95±1.786.02±1.48 5.95±2.23 7.01±1.2

PaCO_2 (mmHg) 52±15 45±13.2 50±13.958±11.8

Paw 1 Hour (cmH_2O)26±3.830±4.525±5.1 30±3.9

F_iO2 1 Hour91±12 99±5.393±14.1100±0.0

PaO_2 1 Hour (mmHg) 117±75.8103±54.6157±84.6 161±88.4

P_{aw} 24 Hours (cmH_2O)24±3.926±5.522±4.4 26±3.6

F_iO_2 24 Hours 61±2.959±8.263±6.5 58±6.8

PaO_2 24 Hours (mmHg) 85±31 86±33.3 91±33.485±22.6

FREQ was decreased in the higher weight groups with a significant difference between groups A and C, and groups A and D (p < 0.001). FREQ adjustments were made in 2/44 patients. The MPS used in group D was significantly higher than in group A (p < 0.05). There was no significant difference in PaCO_2 between groups. The mean P_{aw} on CV was 19.8±3.6 and at one Hr on HFOV was 27.6±4.8 overall. The mean F_iO_2 decreased from .95±10.2 at one Hr to .60±6.3 at 24 Hrs for the entire series of patients. We conclude that 1) lower frequencies are used to ventilate larger patients, 2) ventilation is preferentially managed by adjusting the power control over FREQ, 3) initiation of HFOV with a P_{aw} 7.2±4.3 > CV P_{aw} permits subsequent reduction in F_iO_2 to .60 by 24 Hrs. Whether a strategy utilizing a higher FREQ with the remaining available power would be more beneficial is an area for future investigation.

OF-95-112

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