Department of Pediatrics, Division of Pediatric Critical Care, Penn State Health Children's Hospital, Hershey, Pennsylvania.
Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah.
Respir Care. 2022 Jul;67(7):781-788. doi: 10.4187/respcare.09350. Epub 2022 May 17.
High-frequency percussive ventilation (HFPV) is an alternative mode of mechanical ventilation that has been shown to improve gas exchange in subjects with severe respiratory failure. We hypothesized that HFPV use would improve ventilation and oxygenation in intubated children with acute bronchiolitis.
In this single-center prospective cohort study we included mechanically ventilated children in the pediatric ICU with bronchiolitis 1-24 months old who were transitioned to HFPV from conventional invasive mechanical ventilation from November 2018-April 2020. Patients with congenital heart disease, on extracorporeal membrane oxygenation (ECMO), and with HFPV duration < 12 h were excluded. Subject gas exchange metrics and ventilator parameters were compared before and after HFPV initiation.
Forty-one of 192 (21%) patients intubated with bronchiolitis underwent HFPV, and 35 met inclusion criteria. Median age of cohort was 4 months, and 60% were previously healthy. All subjects with available oxygenation saturation index (OSI) measurements pre-HFPV met pediatric ARDS criteria (31/35, 89%). Mean CO decreased from 65.4 in the 24 h pre-HFPV to 51 ( < .001) in the 24 h post initiation. S /F was significantly improved at 24 h post-HFPV (153.3 to 209.7, = .001), whereas the decrease in mean OSI at 24 h did not meet statistical significance (11.9 to 10.2, = .15). The mean peak inspiratory pressure (PIP) decreased post-HFPV from 29.7 to 25.0 at 24 h ( < .001). No subjects developed an air leak or hemodynamic instability secondary to HFPV. Two subjects required ECMO, and of these, one subject died.
HFPV was associated with significant improvement in ventilation and decreased exposure to high PIPs for mechanically ventilated children with bronchiolitis in our cohort and had a potential association with improved oxygenation. Our study shows that HFPV may be an effective alternative mode of ventilation in patients with bronchiolitis who have poor gas exchange on conventional invasive mechanical ventilation.
高频喷射通气（HFPV）是一种机械通气的替代模式，已被证明可改善严重呼吸衰竭患者的气体交换。我们假设 HFPV 的使用将改善急性毛细支气管炎机械通气患儿的通气和氧合。
在这项单中心前瞻性队列研究中，我们纳入了 2018 年 11 月至 2020 年 4 月从常规有创机械通气转为 HFPV 的儿科 ICU 中患有毛细支气管炎的机械通气患儿。排除患有先天性心脏病、体外膜肺氧合（ECMO）和 HFPV 持续时间 <12 小时的患者。比较 HFPV 启动前后患儿的气体交换指标和呼吸机参数。
192 例毛细支气管炎机械通气患儿中有 41 例（21%）接受了 HFPV 治疗，其中 35 例符合纳入标准。队列的中位年龄为 4 个月，60%的患儿既往健康。所有有血氧饱和度指数（OSI）测量值的患儿在 HFPV 前均符合小儿急性呼吸窘迫综合征标准（31/35，89%）。CO 在 HFPV 前 24 小时从 65.4 降至 51（<0.001）。S/F 在 HFPV 后 24 小时显著改善（153.3 至 209.7，<0.001），而 OSI 的均值在 HFPV 后 24 小时下降无统计学意义（11.9 至 10.2，=0.15）。HFPV 后 24 小时平均峰压（PIP）从 29.7 降至 25.0（<0.001）。没有患儿因 HFPV 发生气胸或血流动力学不稳定。两名患儿需要 ECMO，其中一名患儿死亡。
在我们的队列中，高频喷射通气与机械通气的毛细支气管炎患儿通气显著改善和接触高 PIP 减少有关，与氧合改善有潜在关联。我们的研究表明，高频喷射通气可能是一种有效的替代通气模式，用于常规有创机械通气时气体交换不佳的毛细支气管炎患者。
