High Frequency Oscillatory Ventilation in severe RSV Infection

High frequency oscillatory (HFOV) has been progressively useful in children with severe hypoxemic and hypercapnic respiratory insufficiency. at Pediatric Intensive Care Units. Objectives: To describe our experience in treatment of children with severe RSV infection unresponsive to conventional ventilation (CV), to describe effectiveness in gas exchange and to evaluate the safety of the method. A descriptive and prospective study set at two paediatric intensive care units, in Hospital Roberto del Rio and Clinica Santa Maria of Santiago, Chile between January 2001 and December 2004. Results: 36 patients between 0.5 and 10 months of age with severe RSV infection and respiratory failure unresponsive to mechanical ventilation were connected to HFOV after an average time of conventional ventilation of 2.6 days. Arterial pH improved during the first hour in HFOV from 7.18 to > 7.3. Initial PaO2/FiO(2) in average was 104.8, there was a slow and progressive improvement until 72 hours (138). FiO(2) diminished since an average of 74% till 63.6% at 72 hours pCO(2) went down from an average of 88 mm de Hg pre HFOV to 50 mmHg at 12 hours, remaining low. Oxygenation index, pre HFOV, was in average 18 and it maintained in 17 at 72 hours, with a FiO(2) < 60%. Patients were hold in HFOV between 2-18 days. 3/36 patients died after 1.5, 4 and 18 days of HFOV. 8,3% presented air leak. One of these patients is oxygen dependent after 12 months of following. Conclusions: High frequency oscillatory ventilation is a useful method in the management of acute respiratory failure in children with severe infection for RSV unresponsive to conventional ventilation. It can improve gas exchange slowly and progressively with a low risk of air leak. secuelae and death.