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High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis

Berner, Michel ; Hanquinet, Sylviane ; Rimensberger, Peter

In: Intensive Care Medicine, 2008, vol. 34, no. 9, p. 1698-1702

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    Titre
    • High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis
    Auteur
    • Berner, Michel. Neonatology and Paediatric Intensive Care Service, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
    • Hanquinet, Sylviane. Paediatric Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
    • Rimensberger, Peter. Neonatology and Paediatric Intensive Care Service, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:313813
    Summary
    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) cmH2O during HFOVi (P<0.05), then decreased to 11.1(1.3) at HFOVe (P<0.05). Mean FiO2 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) cmH2O (HFOVi) to 21.1 (7.7) P<0.05 (HFOVe) while mean (SD) PaCO2 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 120h. 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