High-frequency oscillatory ventilation in children with hematologic neoplasms and other causes induced acute hypoxic respiratory failure

Objective To evaluate the significance of high-frequency oscillatory ventilation (HFOV) used in acute hypoxic respiratory failure (AHRF) children, failing to conventional ventilation. Methods This was a retrospective study of AHRF children ventilated by HFOV from January 2011 to September, 2013. All patients were initially treated by conventional mechanical ventilation (CMV), and changed to be treated by HFOV if the patient met to one of the following criteria after the CMV parameters of PIP>30 mmH2O (1 cmH2O＝0.098 kPa) or PEEP>10 cmH2O with FiO2100%: (1) SpO2 80 mmHg); (3) serious air leakage (mediastinal emphysema or pneumothorax). The following parameters were recorded: patient′s gender, age, living PICU time, CMV ventilation time, HFOV ventilation time. We reviewed ventilation parameter settings (MAP, ΔP, F, FiO2), oxygenation index (PaO2/FiO2, OI), arterial blood gas, heart rate, blood pressure at different time points including late CMV (H0), 2 h after HFOV (H2), 6 h after HFOV (H6), 12 h after HFOV (H12), 24 h after HFOV (H24) and 48 h after HFOV (H48), respectively. Various indexes at different time points were compared between survival group and death group, oncology group and no-oncology group. Results PaO2 at H2 compared with H0 had significant improvement[76.9 (61.9~128.0) mmHg vs 50.1 (49.5~68.0) mmHg, P＝0.006]。PaO2/FiO2 at H2, H48 had significant improvement compared with those at H0, H24[94.9 (66.8~138.9) mmHg vs 68.0 (49.5~86.8) mmHg, P＝0.039; 135.0 (77.6~240.0) mmHg vs 90.7 (54.6~161.7) mmHg, P＝0.023)]. All children′s systolic pressure, diastolic blood pressure, heart rate at various time points had no difference (P>0.05). Compared to death group (n＝14), PaO2/FiO2, OI at H6, H12, H24, H48 in survival group (n＝9) had significant improvement (P<0.05). Compared to oncology group (n＝10), OI at H2, H6 in no-oncology group (n＝10) had significant improvement [(19.2 (13.9~26.6) vs 33.8 (19.7~48.3), P＝0.049; 16.0 (8.4~27.1) vs 28.9 (20.9~38.9), P＝0.027)], and mean airway pressure between two groups at H2, H6, H12 had significant improvement (P<0.05). Mortality had no significant differcence between two groups (4/10 vs 10/13, P＝0.086). Conclusion HFOV used in children with AHRF which had failed with CMV ventilation can improve the patient′s PaO2 and OI. Heart rate and blood pressure are stable during HFOV treatment. Oncology group patients needed higher initial MAP to improve oxygenation than no-oncology group patients when changed to HFOV treatment, but the mortality showed no difference between two groups. Key words: High-frequency oscillatory ventilation; Acute hypoxemic respiratory failure; Acute respiratory distress syndrome; Children