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Excerpt
Obstructive airway disease (OAD) has been considered a relative contraindication for High frequency oscillation (HFO): "High Volume" (HV) strategy using aggressive lung recruitment to achieve SaO2 >or=to90% has been advocated for use with HFO in peds pts. Permissive ventilation (PV) is a new ventilatory strategy. PV used hypercapnea with pharmacologic pH adjustment >or=to7.30 and tolerates mild hypoxemia (SaO2 >or=to85%) with minimal airway pressure to reduce lung injury and air trapping. We hypothesized that PV used with HFO is an effective method of ventilation in peds pts with OAD.
Methods: In a pilot study, we evaluated peds pts <18y with OAD (confirmed by waveform analysis) who failed conventional ventilation (CV) [oxygenation index (OI)>20]. 15 pts who fulfilled ARDS criteria were included. 7 pts were ventilated prospectively using a PV protocol and compared with 8 pts (historical controls) ventilated with HV protocol. Data were collected initially, every 12h for 3 days, then daily. Success is defined as transition to CV and extubation. Barotrauma is persistence of air leak >48h or requirement of additional chest tubes.
Statistics: Continuous data were analyzed by the Mann-Whitney U-test, Fisher's exact test was used for categorical data. All data were reported using mean +/- SE.
Results: Both groups were comparable in ages, lung injury scores (LIS), PRISM scores and degree of MOSF. Table 1
There were no significant complications in the PV group. The importance of increased Immunocompromise in the PV group is unclear. Three HV group pts required ECMO. None of the PV group required further rescue therapy.
Conclusion: Data from this pilot study indicates that the rationale for further randomized studies is valid. PV strategy applied with HFO may be safe and effective in peds pts with obstructive airway disease.
