Ventilación de alta frecuencia oscilatoria en pacientes pediátricos. Protocolo de aplicación y resultados preliminaries

Resumo

Background High-frequency oscillatory ventilation (HFOV) constitutes an important advance in the management of children with respiratory failure. Although it has been used mainly as "lung rescue therapy", pediatric indications for HFOV can be broader. The principal advantages of this modality compared with conventional ventilation are the lower incidence of barotrauma, volutrauma, atelectrauma and biotrauma. To date, experience with HFOV in our country has been scarce and limited to neonatal patients Objetives To describe the HFOV protocol for pediatric patients and to report the preliminary results of its prospective application. Methods An HFOV protocol was established with the following inclusion criteria: severe respiratory insufficiency of any origin (infectious, inhalatory, etc.) with an oxygenation index (OI) > 13 in two arterial blood gases within a 6hour interval, refractory acute respiratory distress syndrome (ARDS), severe respiratory syncytial virus pneumonia, and gross airleak syndromes (pneumothorax, pneumoperitoneum, pneumomediastinum, etc.). Conventional and HFOV ventilatory, gasometric and hemodynamic parameters of patients included in the protocol during a 5-month period were registered, and the first 24 hours were analyzed. Results Six patients aged between 3 days and 8 years, weighing between 4 and 80 kg met the inclusion criteria. In all patients HVOF was indicated due to severe refractory ARDS. The pre-HFOV mean OI was 45.9. After 1 hour of HFOV mean OI decreased to 23.9 and continued to improve during the first 24 hours. In all patients, normal arterial PO2 and PCO2 were obtained and FiO2 could be set below 0.6 within the first 3 hours of HFOV. No complications associated with HFOV were detected. Outcome was satisfactory in two patients while four patients died secondary to multiorgan failure. conclusions HFOV is a safe and effective ventilatory modality in critically ill pediatric patients in whom conventional ventilation is not effective. To obtain better results, HFOV should be started early. Every child with refractory respiratory failure should be referred early to centers where HFOV can be offered.