Outcome of neonates receiving high frequency oscillation ventilation in a tertiary care institution
DOI:
https://doi.org/10.18203/2349-3291.ijcp20191521Keywords:
HFOV, Neonates, Respiratory failure, VentilationAbstract
Background: High-frequency ventilation is defined as ventilation at a frequency greater than four times normal respiratory rate. HFOV has been used as alternative to conventional ventilation and in respiratory failure of various etiologies. The aim of the study was to identify the indications of neonates receiving HFOV, following failure of conventional ventilation.
Methods: Total 93 neonates were enrolled in the study who received HFOV. The criteria for starting HFOV, the ventilator settings, CBG and ABG analysis, oxygenation index (OI), duration of ventilation and complications of ventilation were recorded during CMV and subsequently when shifted over to HFOV. Outcomes such as oxygenation, lung recruitment and ventilation and survival were monitored.
Results: Total 66 neonates (71%) were term babies. Among the 27 preterm 18 (18.4%) were 33-34±6 weeks of gestational age. Male were 50 in number (53.8%) and female were 43 (46.2%). The male: female ratio was 50:43. Disease specific survival analysis revealed more than 50% survival in cases of pneumonia, collapse, air leak, MAS and pulmonary hemorrhage. 16 out of 33 babies (48.5%) with PPHN survived. All 3 babies with CDH expired. Of the 93 neonates included in the study, 53 (57%) of them were discharged home. The major complications noted while on HFOV were- 38 neonates (40.8%) had air leaks. Instead of, ventilator associated pneumonia was present in 42 of them (45.1%) and none of them developed IVH or NTB (Necrotising tracheo bronchitis).
Conclusions: HFOV is a safe and effective technique in the treatment of neonates with respiratory failure in whom CMV fails. The results of present study show that rescue HFOV improved oxygenation, ventilation and lung recruitment and there was no increased incidence of IVH.
References
Henderson-Smart DJ, De Paoli AG, Clark RH, Bhuta T. High frequency oscillatory ventilation versus conventional ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Systematic Rev. 2009;3:CD002974.
Graciano AL, Freid EB. High-frequency oscillatory ventilation in infants and children. Curr Opin Anesthesiol. 2002;15(2):161-6.
Bunnell JB. High-frequency ventilation; general concepts. In: Donn SM, Sinha SK, eds. Neonatal Respiratory Care. 2nd Ed Philadelphia: Mosby, Inc. 2006:222-30.
Clark RH, Yoder BA, Sell MS. Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr. 1994;124(3):447-54.
Carter JM, Gerstmann DR, Clark RH, Snyder MG, Cornish JD, Null DM. High-frequency oscillatory ventilation and extracorporeal membrane oxygenation for the treatment of acute neonatal respiratory failure. Pediatr. 1990;85(2):159-64.
Pillow JJ. High-frequency oscillatory ventilation: mechanisms of gas exchange and lung mechanics. Critical Care Med. 2005;33(3):S135-41.
Attar MA, Donn SM. Mechanisms of ventilator-induced lung injury in premature infants. In Seminars Neonatol. 2002;7(5):353-60.
Mcculloch PR, Forkert PG, Froese AB. Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis. 1988;137(5):1185-92.
Clark RH, Yoder BA, Sell MS. Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr. 1994;124(3):447-54.
Kohelet DA, Perlman M, Kirpalani HA, Hanna GI, Koren GI. High-frequency oscillation in the rescue of infants with persistent pulmonary hypertension. Critical Care Med. 1988;16(5):510-6.
Henderson-Smart DJ, Bhuta T, Cools F, Offringa M. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev. 2001;(3):CD000104.
Poddutoor PK, Chirla DK, Sachane K, Shaik FA, Venkatlakshmi A. Rescue high frequency oscillation in neonates with acute respiratory failure. Indian Pediatr. 2011;48(6):467-0.
Fok TF, Ng PC, Wong W, Lee CH, So KW. High frequency oscillatory ventilation in infants with increased intra-abdominal pressure. Archives Dis Childhood-Fetal Neonatal Edit. 1997;76(2):F123-5.
Wong W, Fok TF, Ng PC, Cheung KL. High frequency ventilation in neonates. HK J Pediatr. 2003;8:113-20.
