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 PrapphaiDivision of Pediatric Critical Care, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 10330; E‑mail: [email protected]
บทคัดย่อ
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.
ที่มา
Indian Journal of Critical Care Medicine ปี 2559, February
ปีที่: 20 ฉบับที่ 2 หน้า 72-77
คำสำคัญ
Oxygenation, Conventional ventilation, high frequency oscillatory ventilation, lung volume recruitment maneuver
