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High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis

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Abstract

Objective

To describe the time course of high frequency oscillatory ventilation (HFOV) in respiratory syncytial virus (RSV) bronchiolitis.

Design

Retrospective charts review.

Setting

A tertiary paediatric intensive care unit.

Patients and participants

Infants with respiratory failure due to RSV infection.

Intervention

HFOV.

Measurements and results

Pattern of lung disease, ventilatory settings, blood gases, infant’s vital parameters, sedation and analgesia during the periods of conventional mechanical ventilation (CMV, 6 infants), after initiation of HFOV (HFOVi, 9 infants), in the middle of its course (HFOVm), at the end (HFOVe) and after extubation (Post-Extub) were compared. All infants showed a predominant overexpanded lung pattern. Mean airway pressure was raised from a mean (SD) 12.5 (2.0) during CMV to 18.9 (2.7) cmH2O during HFOVi (P < 0.05), then decreased to 11.1(1.3) at HFOVe (P < 0.05). Mean FiO2 was reduced from 0.68 (0.18) (CMV) to 0.59 (0.14) (HFOVi) then to 0.29 (0.06) (P < 0.05) at HFOVe and mean peak to peak pressure from 44.9 (12.4) cmH2O (HFOVi) to 21.1 (7.7) P < 0.05 (HFOVe) while mean (SD) PaCO2 showed a trend to decrease from 72 (22) (CMV) to 47 (8) mmHg (HFVOe) and mean infants respiratory rate a trend to increase from 20 (11) (HFOVi) to 34 (14) (HFOVe) breaths/min. With usual doses of sedatives and opiates, no infant was paralysed and all were extubated to CPAP or supplemental oxygen after a mean of 120 h.

Conclusion

RSV induced respiratory failure with hypercapnia can be managed with HFOV using high mean airway pressure and large pressure swings while preserving spontaneous breathing.

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Author information

Authors and Affiliations

  1. Neonatology and Paediatric Intensive Care Service, Geneva University Hospitals and University of Geneva, Geneva, Switzerland

    Michel E. Berner

  2. Paediatric Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland

    Sylviane Hanquinet

  3. Neonatology and Paediatric Intensive Care Service, Geneva University Hospitals and University of Geneva, Geneva, Switzerland

    Peter C. Rimensberger

Authors
  1. Michel E. Berner
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  2. Sylviane Hanquinet
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  3. Peter C. Rimensberger
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Corresponding author

Correspondence to Michel E. Berner.

Additional information

This article is discussed in the editorial available at doi:10.1007/s00134-008-1152-2.

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Berner, M.E., Hanquinet, S. & Rimensberger, P.C. High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis. Intensive Care Med 34, 1698–1702 (2008). https://doi.org/10.1007/s00134-008-1151-3

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  • DOI: https://doi.org/10.1007/s00134-008-1151-3

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