High Frequency Oscillatory Ventilation for Respiratory Failure Due to RSV Bronchiolitis

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2008 May 27

PMID 18500423

Citations 8

Authors

Michel E Berner

Sylviane Hanquinet

Peter C Rimensberger

Affiliations

Soon will be listed here.

Abstract

Objective: To describe the time course of high frequency oscillatory ventilation (HFOV) in respiratory syncytial virus (RSV) bronchiolitis.

Design: Retrospective charts review.

Setting: A tertiary paediatric intensive care unit.

Patients And Participants: Infants with respiratory failure due to RSV infection.

Intervention: HFOV.

Measurements And Results: Pattern of lung disease, ventilatory settings, blood gases, infant's vital parameters, sedation and analgesia during the periods of conventional mechanical ventilation (CMV, 6 infants), after initiation of HFOV (HFOVi, 9 infants), in the middle of its course (HFOVm), at the end (HFOVe) and after extubation (Post-Extub) were compared. All infants showed a predominant overexpanded lung pattern. Mean airway pressure was raised from a mean (SD) 12.5 (2.0) during CMV to 18.9 (2.7) cmH(2)O during HFOVi (P < 0.05), then decreased to 11.1(1.3) at HFOVe (P < 0.05). Mean FiO(2) was reduced from 0.68 (0.18) (CMV) to 0.59 (0.14) (HFOVi) then to 0.29 (0.06) (P < 0.05) at HFOVe and mean peak to peak pressure from 44.9 (12.4) cmH(2)O (HFOVi) to 21.1 (7.7) P < 0.05 (HFOVe) while mean (SD) PaCO(2) showed a trend to decrease from 72 (22) (CMV) to 47 (8) mmHg (HFVOe) and mean infants respiratory rate a trend to increase from 20 (11) (HFOVi) to 34 (14) (HFOVe) breaths/min. With usual doses of sedatives and opiates, no infant was paralysed and all were extubated to CPAP or supplemental oxygen after a mean of 120 h.

Conclusion: RSV induced respiratory failure with hypercapnia can be managed with HFOV using high mean airway pressure and large pressure swings while preserving spontaneous breathing.

Citing Articles

Pediatric Respiratory Syncytial Virus Hospitalizations and Respiratory Support After the COVID-19 Pandemic.

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Efficacy and safety of exogenous surfactant therapy in patients under 12 months of age invasively ventilated for severe bronchiolitis (SURFABRON): protocol for a multicentre, randomised, double-blind, controlled, non-profit trial.

Biban P, Conti G, Wolfler A, Carlassara S, Gitto E, Rulli I BMJ Open. 2020; 10(10):e038780.

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Valentine K, Sarnaik A, Sandhu H, Sarnaik A Front Pediatr. 2016; 4:92.

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Acute bronchiolitis in infants, a review.

Oymar K, Skjerven H, Bruun Mikalsen I Scand J Trauma Resusc Emerg Med. 2014; 22:23.

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High-frequency oscillatory ventilation and short-term outcome in neonates and infants undergoing cardiac surgery: a propensity score analysis.

Bojan M, Gioanni S, Mauriat P, Pouard P Crit Care. 2011; 15(5):R259.

PMID: 22035562 PMC: 3334810. DOI: 10.1186/cc10521.

References

Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez J . Nasal continuous positive airway pressure with heliox in infants with acute bronchiolitis. Respir Med. 2006; 100(8):1458-62. DOI: 10.1016/j.rmed.2005.11.026. View

Slee-Wijffels F, van der Vaart K, Twisk J, Markhorst D, Plotz F . High-frequency oscillatory ventilation in children: a single-center experience of 53 cases. Crit Care. 2005; 9(3):R274-9. PMC: 1175892. DOI: 10.1186/cc3520. View

Gerstmann D, Minton S, Stoddard R, Meredith K, Monaco F, BERTRAND J . The Provo multicenter early high-frequency oscillatory ventilation trial: improved pulmonary and clinical outcome in respiratory distress syndrome. Pediatrics. 1996; 98(6 Pt 1):1044-57. View

Thompson M, Bates J, Klein J . Treatment of respiratory failure in an infant with bronchopulmonary dysplasia infected with respiratory syncytial virus using inhaled nitric oxide and high frequency ventilation. Acta Paediatr. 1995; 84(1):100-2. DOI: 10.1111/j.1651-2227.1995.tb13497.x. View

Leclerc F, Scalfaro P, Noizet O, Thumerelle C, Dorkenoo A, Fourier C . Mechanical ventilatory support in infants with respiratory syncytial virus infection. Pediatr Crit Care Med. 2003; 2(3):197-204. DOI: 10.1097/00130478-200107000-00002. View

Tasker R, Gordon I, Kiff K . Time course of severe respiratory syncytial virus infection in mechanically ventilated infants. Acta Paediatr. 2000; 89(8):938-41. DOI: 10.1080/080352500750043387. View

Hammer J, Numa A, Newth C . Acute respiratory distress syndrome caused by respiratory syncytial virus. Pediatr Pulmonol. 1997; 23(3):176-83. DOI: 10.1002/(sici)1099-0496(199703)23:3<176::aid-ppul2>3.0.co;2-m. View

Kneyber M, Plotz F, Sibarani-Ponsen R, Markhorst D . High-frequency oscillatory ventilation (HFOV) facilitates CO2 elimination in small airway disease: the open airway concept. Respir Med. 2005; 99(11):1459-61. DOI: 10.1016/j.rmed.2005.03.013. View

Thia L, McKenzie S, Blyth T, Minasian C, Kozlowska W, Carr S . Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child. 2007; 93(1):45-7. DOI: 10.1136/adc.2005.091231. View

10.

Pillow J . High-frequency oscillatory ventilation: mechanisms of gas exchange and lung mechanics. Crit Care Med. 2005; 33(3 Suppl):S135-41. DOI: 10.1097/01.ccm.0000155789.52984.b7. View

11.

Medbo S, FINNE P, Hansen T . Respiratory syncytial virus pneumonia ventilated with high-frequency oscillatory ventilation. Acta Paediatr. 1997; 86(7):766-8. DOI: 10.1111/j.1651-2227.1997.tb08584.x. View

12.

Liet J, Millotte B, Tucci M, Laflammme S, Hutchison J, Creery D . Noninvasive therapy with helium-oxygen for severe bronchiolitis. J Pediatr. 2005; 147(6):812-7. DOI: 10.1016/j.jpeds.2005.07.015. View

13.

van Genderingen H, van Vught A, Duval E, Markhorst D, Jansen J . Attenuation of pressure swings along the endotracheal tube is indicative of optimal distending pressure during high-frequency oscillatory ventilation in a model of acute lung injury. Pediatr Pulmonol. 2002; 33(6):429-36. DOI: 10.1002/ppul.10103. View

14.

Pillow J, Sly P, Hantos Z, Bates J . Dependence of intrapulmonary pressure amplitudes on respiratory mechanics during high-frequency oscillatory ventilation in preterm lambs. Pediatr Res. 2002; 52(4):538-44. DOI: 10.1203/00006450-200210000-00013. View

15.

Duval E, Leroy P, Gemke R, Van Vught A . High-frequency oscillatory ventilation in RSV bronchiolitis patients. Respir Med. 1999; 93(6):435-40. DOI: 10.1053/rmed.1999.0578. View

16.

Campion A, Huvenne H, Leteurtre S, Noizet O, Binoche A, Diependaele J . [Non-invasive ventilation in infants with severe infection presumably due to respiratory syncytial virus: feasibility and failure criteria]. Arch Pediatr. 2006; 13(11):1404-9. DOI: 10.1016/j.arcped.2006.08.003. View

17.

Greenough A, Kavvadia V, Johnson A, Calvert S, Peacock J, Karani J . A simple chest radiograph score to predict chronic lung disease in prematurely born infants. Br J Radiol. 1999; 72(858):530-3. DOI: 10.1259/bjr.72.858.10560333. View

18.

Chevret L, Mbieleu B, Essouri S, Durand P, Chevret S, Devictor D . [Bronchiolitis treated with mechanical ventilation: prognosis factors and outcome in a series of 135 children]. Arch Pediatr. 2005; 12(4):385-90. DOI: 10.1016/j.arcped.2005.01.008. View

19.

Duval E, Van Vught A . Status asthmaticus treated by high-frequency oscillatory ventilation. Pediatr Pulmonol. 2000; 30(4):350-3. DOI: 10.1002/1099-0496(200010)30:4<350::aid-ppul13>3.0.co;2-2. View

20.

Larrar S, Essouri S, Durand P, Chevret L, Haas V, Chabernaud J . [Effects of nasal continuous positive airway pressure ventilation in infants with severe acute bronchiolitis]. Arch Pediatr. 2006; 13(11):1397-403. DOI: 10.1016/j.arcped.2006.07.005. View