A comparison of clinical efficacy between high frequency oscillatory ventilation and conventional ventilation with lung volume recruitment in pediatric acute respiratory distress syndrome: A randomized controlled trial

Rujipat Samransamruajkit*, Chavisa Rassameehirun, Khemmachart Pongsanon, Sumalee Huntrakul, Jitladda Deerojanawong, Suchada Sritippayawan, Nuanchan Prapphai
Division of Pediatric Critical Care, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 10330; E‑mail: rujipatrs@gmail.com

Purpose: To determine the efficacy of lung volume recruitment maneuver (LVRM)

with high frequency oscillatory ventilation (HFOV) on oxygenation, hemodynamic

alteration, and clinical outcomes when compared to conventional mechanical

ventilation (CV) in children with severe acute respiratory distress syndrome (ARDS).

Materials: We performed a randomized controlled trial and enrolled pediatric patients

who were diagnosed to have severe ARDS upon pediatric intensive care unit (PICU)

admission. LVRM protocol combined with HFOV or conventional mechanical ventilation

was used. Baseline characteristic data, oxygenation, hemodynamic parameters, and

clinical outcomes were recorded. Results: Eighteen children with severe ARDS were

enrolled in our study. The primary cause of ARDS was pneumonia (91.7%). Their mean

age was 47.7 ± 61.2 (m) and body weight was 25.3 ± 27.1 (kg). Their initial pediatric

risk of mortality score 3 and pediatric logistic organ dysfunction were 12 ± 9.2 and

15.9 ± 12.8, respectively. The initial mean oxygen index was 24.5 ± 10.4, and mean

PaO₂/FiO₂ was 80.6 ± 25. There was no difference in oxygen parameters at baseline

the between two groups. There was a significant increase in PaO₂/FiO₂ (119.2 ± 41.1,

49.6 ± 30.6, P = 0.01*) response after 1 h of LVRM with HFOV compare to CV.

Hemodynamic and serious complications were not significantly affected after LVRM.

The overall PICU mortality of our severe ARDS at 28 days was 16.7%. Three patients

in CV with LVRM group failed to wean oxygen requirement and were cross‑over to

HFOV group. Conclusions: HFOV combined with LVRM in severe pediatric ARDS

had superior oxygenation and tended to have better clinical effect over CV. There is

no significant effect on hemodynamic parameters. Moreover, no serious complication

was noted.

Indian Journal of Critical Care Medicine ปี 2559, February ปีที่: 20 ฉบับที่ 2 หน้า 72-77

Oxygenation, Conventional ventilation, high frequency oscillatory ventilation, lung volume recruitment maneuver