Hfov

Mechanical ventilation (MV), although life-saving, is associated with chronic respiratory morbidity in both preterm and term born infants. New ventilation modes have been developed with the aim of minimising lung injury. These include invasive and non-invasive respiratory support strategies, techniques for less invasive surfactant administration (LISA) and closed-loop automated oxygen control (CLAC) systems. Increasingly, newborn infants with signs of respiratory distress are stabilised on continuous positive airway pressure (CPAP) and receive LISA...

OBJECTIVE: Congenital Diaphragmatic Hernia (CDH) is diagnosed prenatally in ~60% of cases. Prenatal measures typically guide management and prognostication. Simple postnatal prognosticators are needed when prenatal diagnosis is lacking. We hypothesized that preoperative orogastric tube (OGT) tip position relative to the contralateral diaphragm correlates with defect severity, resource utilization, and clinical outcomes regardless of diagnostic status. STUDY DESIGN: 150 neonates with left-posterolateral CDH were analyzed...

INTRODUCTION: Pulmonary complications such as acute respiratory distress syndrome and refractory respiratory failure have been major causes of morbidity and mortality after cardiac surgery in children. Patients are usually transitioned to either high-frequency oscillatory ventilation (HFOV) or extracorporeal membrane oxygenation (ECMO) as "salvage therapy" when the maximal medical management and controlled mechanical ventilation (CMV) become ineffective. MATERIAL AND METHODS: A retrospective review of paediatric patients who underwent congenital heart surgery and developed cardiorespiratory failure during their stay in a paediatric cardiac ICU, refractory to maximal CMV, was performed in the study...

Introduction: Chloral hydrate (CH) has long been utilized as a pediatric procedural sedation agent. However, very little is published describing CH use in a pediatric intensive care unit (PICU) setting. The aim of this retrospective observational cohort study was to investigate and describe the use of CH in mechanically-ventilated, critically ill children at a large pediatric tertiary referral hospital. Methods: Data were extracted from the hospital electronic medical record and a locally maintained registry of all children admitted to the PICU between 2012 and 2017...

CONTEXT: Despite advances in neonatal intensive care, surgical methods, and anesthesia, congenital diaphragmatic hernia (CDH) is still associated with significant mortality. Predicting which babies will have poorer outcomes is essential to identify the high-risk babies and to give targeted care and accurate prognosis to the parents, especially in a resource crunch set-up. AIMS: The aim of this study is to evaluate the antenatal and postnatal prognostic factors in neonatal CDH that can be used to predict the outcome...

BACKGROUND: Insufficient data are available about the noise produced by modern neonatal ventilators. We aimed to measure their noise under different ventilatory modes and parameters. METHODS: This was a bench study measuring the noise produced by 9 neonatal ventilators set in conventional or high-frequency oscillatory ventilation (HFOV), nasal mask-delivered CPAP with variable- or continuous-flow configuration, or bi-level positive airway pressure (considered as noninvasive ventilation [NIV])...

INTRODUCTION: Congenital diaphragmatic hernia (CDH) remains a cause of neonatal death. Our aims are to describe contemporary rates of survival and the variables associated with this outcome, contrasting these with our study of two decades earlier and recent reports. MATERIALS AND METHODS: A retrospective review of all infants diagnosed in a regional center between January 2000 and December 2020 was performed. The outcome of interest was survival. Possible explanatory variables included side of defect, use of complex ventilatory or hemodynamic strategies (inhaled nitric oxide (iNO), high-frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and Prostin), presence of antenatal diagnosis, associated anomalies, birth weight, and gestation...

INTRODUCTION: Patients with acute respiratory distress syndrome (ARDS) on mechanical ventilation often require high inspiratory pressure and positive end-expiratory pressure (PEEP). However, effective ventilation becomes difficult in cases where a large air leak develops in patients. The management of such a case requires improvisation and the adoption of special ventilation strategies. CASE AND OUTCOMES: We present a case study of a burn patient with airway involvement, developing ARDS and who developed a bronchopleural fistula (BPF) leading to failure of conventional ventilation...

OBJECTIVES: To study the hemodynamic consequences of an open-lung high-frequency oscillatory ventilation (HFOV) strategy in patients with an underlying cardiac anomaly with or without intracardiac shunt or primary pulmonary hypertension with severe lung injury. DESIGN: Secondary analysis of prospectively collected data. SETTING: Medical-surgical PICU. PATIENTS: Children less than 18 years old with cardiac anomalies (± intracardiac shunt) or primary pulmonary hypertension...

PURPOSE OF REVIEW: The purpose was to examine the utility of high-frequency oscillatory ventilation (HFOV) in trauma and burn ICU patients who require mechanical ventilation, and provide recommendations on its use. RECENT FINDINGS: HFOV may be beneficial in burn patients with smoke inhalation injury with or without acute lung injury/acute respiratory distress syndrome (ARDS), as it improves oxygenation and minimizes ventilator-induced lung injury. It also may have a role in improving oxygenation in trauma patients with blast lung injury, pulmonary contusions, pneumothorax with massive air leak, and ARDS; however, the mortality benefit is unknown...

Therapeutic recommendations for pediatric acute respiratory distress syndrome (PARDS) include conventional (CMV) and rescue high-frequency oscillatory mode (HFOV) of mechanical ventilation (MV). The pediatric risk of mortality (PRISM) is a frequently used mortality score for critically ill patients. In search of methods to recognize those patients, we analyzed the PRISM III score as a potential predictor of the short-term outcome in MV subjects with PARDS. A retrospective five-year study of PARDS in children on MV was conducted in the Pediatric ICU...

OBJECTIVES: To study the clinical efficacy of volume-targeted ventilation (VTV) versus high-frequency oscillatory ventilation (HFOV) in the treatment of neonatal respiratory distress syndrome (NRDS). METHODS: A retrospective cohort analysis was performed on the medical data of 140 neonates with severe NRDS who were admitted from September 2016 to February 2022, with 55 neonates in the VTV group and 85 in the HFOV group. The neonates in the VTV group received conventional mechanical ventilation and target tidal volume, and those in the HFOV group received HFOV...

INTRODUCTION: Bronchopulmonary dysplasia (BPD) remains one of the major challenges of extreme prematurity. High-frequency oscillatory ventilation (HFOV) with volume guarantee (HFOV-VG) can be used as an early-rescue ventilation to protect developing lungs. However, the studies exploring the impact of this ventilatory strategy on neonatal respiratory morbidity are very limited. This study aimed at documenting the improvement in respiratory outcomes in mechanically ventilated preterm newborns, after the implementation of a new mechanical ventilation respiratory bundle...

BACKGROUND: Lung recruitment maneuvers (LRMs) improve lung volume at initiation of high-frequency oscillatory ventilation (HFOV), but it is unclear when to repeat LRMs. We evaluated the efficiency of scheduled LRMs. METHODS: In a randomized controlled trial, extremely preterm infants on HFOV received either LRMs at 12-hour intervals and when clinically indicated (intervention) or only when clinically indicated (control). The primary outcome was the cumulative oxygen saturation index (OSI) over HFOV time, limited to 7 days...

OBJECTIVE: To investigate the association between early neonatal respiratory management in infants with bronchopulmonary dysplasia (BPD) and the degree of pulmonary ventilation perfusion-matching (V/Q) at term. METHODS: 30 preterm infants with a diagnosis of BPD who were initially treated with either controlled mechanical ventilation/continuous positive airway pressure (CMV/CPAP) (n = 14) or high-frequency oscillatory ventilation (HFOV) using a high lung-volume strategy (n = 16) were retrospectively included in this study...

BACKGROUND: Neonatal acute respiratory distress syndrome (NARDS) was defined in 2017 and the epidemiological data remain unknown. Our objective was to explore aetiological factors, clinical characteristics and outcomes in patients with perinatal NARDS. METHODS: A multicentre, prospective, cross-sectional study was performed in 58 tertiary neonatal intensive care units in China from Jan 1, 2018 to June 30, 2019. Neonates diagnosed with NARDS were included. Primary outcomes were aetiological factors, clinical characteristics and outcomes...

Pulmonary hemorrhage (PH) is a rare acute catastrophic event with high mortality among neonates, especially preterm infants. Primary treatments included pulmonary surfactant, high-frequency oscillatory ventilation, epinephrine, coagulopathy management, and intermittent positive pressure ventilation. However, there are still challenges in diagnosing and treating refractory or focal pulmonary hemorrhages. Ultra-slim bronchoscopy has been widely used in the field of critically ill children and is increasingly being done in neonates with critical respiratory disease in recent years...

OBJECTIVE: This study aimed to evaluate the efficacy and safety of high-frequency oscillation ventilation combined with volume guarantee (HFOV-VG) in preterm infants with acute hypoxemic respiratory failure (AHRF) after patent ductus arteriosus ligation. METHODS: We retrospectively analyzed the clinical data of 41 preterm infants, who were ventilated for AHRF after patent ductus arteriosus ligation between January 2020 and January 2022. HFOV alone was used in 20 of the 41 infants, whereas HFOV-VG was used in the other 21 infants...

OBJECTIVE:  Persistent pulmonary hypertension of the newborn (PPHN) is a serious cardiorespiratory problem. PPHN is frequently associated with refractory hypoxia and hypotension, and optimal management has the potential to improve important clinical outcomes including mortality. The primary objective is to evaluate the efficacy and safety of rescue vasopressin (VP) therapy in the management of severe (refractory) hypoxia and refractory systemic hypotension in term neonates with severe PPHN...

High-frequency oscillatory ventilation (HFOV) is a ventilatory modality widely used in neonatal intensive care units. Its main indication is restrictive lung pathology with difficult gas exchange using conventional mechanical ventilation (CMV). Patients receiving CMV require high intensity care, and immature lungs can be at risk for barotrauma and volutrauma. The few studies that have explored the use of HFOV in the operating room are mainly limited to HFVO during congenital diaphragmatic hernia repair. Limited experience of this ventilatory method in the operating room may be a disadvantage for the anesthesiologist...