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Am J Respir Crit Care Med. 2016 Mar 1;193(5):495-503. doi: 10.1164/rccm.201507-1381OC.

Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis.

Author information

1
1 Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts.
2
2 Department of Pediatrics, University of Alabama, Birmingham, Alabama.
3
3 Department of Cardiology and.
4
4 Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
5
5 Department of Pediatrics, University of California, San Francisco, San Francisco, California.
6
6 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
7
7 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and.
8
10 Department of Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts.
9
8 Department of Family and Community Health, School of Nursing and.
10
9 Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

RATIONALE:

The use of high-frequency oscillatory ventilation (HFOV) for acute respiratory failure in children is prevalent despite the lack of efficacy data.

OBJECTIVES:

To compare the outcomes of patients with acute respiratory failure managed with HFOV within 24-48 hours of endotracheal intubation with those receiving conventional mechanical ventilation (CMV) and/or late HFOV.

METHODS:

This is a secondary analysis of data from the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) study, a prospective cluster randomized clinical trial conducted between 2009 and 2013 in 31 U.S. pediatric intensive care units. Propensity score analysis, including degree of hypoxia in the model, compared the duration of mechanical ventilation and mortality of patients treated with early HFOV matched with those treated with CMV/late HFOV.

MEASUREMENTS AND MAIN RESULTS:

Among 2,449 subjects enrolled in RESTORE, 353 patients (14%) were ever supported on HFOV, of which 210 (59%) had HFOV initiated within 24-48 hours of intubation. The propensity score model predicting the probability of receiving early HFOV included 1,064 patients (181 early HFOV vs. 883 CMV/late HFOV) with significant hypoxia (oxygenation index ≥ 8). The degree of hypoxia was the most significant contributor to the propensity score model. After adjusting for risk category, early HFOV use was associated with a longer duration of mechanical ventilation (hazard ratio, 0.75; 95% confidence interval, 0.64-0.89; P = 0.001) but not with mortality (odds ratio, 1.28; 95% confidence interval, 0.92-1.79; P = 0.15) compared with CMV/late HFOV.

CONCLUSIONS:

In adjusted models including important oxygenation variables, early HFOV was associated with a longer duration of mechanical ventilation. These analyses make supporting the current approach to HFOV less convincing.

KEYWORDS:

high-frequency oscillatory ventilation; mechanical ventilation; oxygenation index; pediatric acute respiratory distress syndrome

PMID:
26492410
PMCID:
PMC4824923
[Available on 2017-03-01]
DOI:
10.1164/rccm.201507-1381OC
[Indexed for MEDLINE]
Free PMC Article

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