Predicting outcome in children with severe acute respiratory failure treated with high-frequency ventilation

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Abstract
Objectives a) To demonstrate the effect of high-frequency ventilation on gas exchange in children with severe acute respiratory failure unresponsive to conventional ventilation; b) to identify patients at high risk of death early after institution of high-frequency ventilation. Setting Tertiary care pediatric intensive care unit in a university hospital. Design A cross-sectional, observational study with factorial design. Patients Thirty-one patients with severe acute respiratory failure defined as a PaO2/FIO2 of 2 O and/or PaCO2 of >60 torr (>8 kPa) with an arterial pH 2, PaO2, and PaO2/FIO2 6 hrs after institution of high-frequency ventilation (p < .01). This improvement, along with decreased need for oxygen, was sustained through the subsequent course. Twenty-three (74%) of 31 children treated with high-frequency ventilation survived. Survivors showed an increase in an arterial pH, PaO2, PaO2/FIO2, and a decrease in PaCO2 within 6 hrs, whereas nonsurvivors did not. Oxygenation index was the best predictor of outcome. A combination of an initial oxygenation index of >20 and failure to decrease the oxygenation index by >20% by 6 hrs after initiation of high-frequency ventilation predicted death with 88% (7/8) sensitivity and 83% (19/23) specificity, with an odds ratio of 33 (p = .0036, 95% confidence interval 3-365). Conclusions In patients with potentially reversible underlying diseases resulting in severe acute respiratory failure that is unresponsive to conventional ventilation, high-frequency ventilation improves gas exchange in a rapid and sustained fashion. The magnitude of impaired oxygenation and its improvement after high-frequency ventilation can predict outcome within 6 hrs. (Crit Care Med 1996; 24:1396-1402)

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