Abstract

Background: High-frequency oscillatory ventilation (HFOV) is an advanced mode of mechanical ventilation, however, its role has been a subject of debate. This study aimed to find patients who are best treated with HFOV and the best selection of HFOV settings in the first 48h.
Methods: A retrospective study was conducted on 207 patients admitted to the pediatric intensive care unit ((PICU) in King Fahad Medical City and switched to HFOV between September 2010 and December 2017.
Results: The median age of our cohort was 12 (interquartile range [IRQ] 4-48) months, and 52.7% were males. The most common cause of respiratory failure was acute respiratory distress syndrome (ARDS) with 100 (48.3 %) cases followed by pneumonia with 34 (16.4%) cases. The majority (87.4%) of participants had a chronic illness. Oxygenation failure was the most frequently reason for using HFOV (77.3%). During first 48 h, significant improvements in oxygenation and ventilation were noted. There was a significant association between 48 h mortality and lower pH, sepsis, high vasopressor index, hypotension, hematological malignancies (odds ratio [OR] 8.73, 95% confidence interval [CI] 1.58-48.06; p = 0.013) and in a group that did not have diffuse alveolar or small airway diseases when compared with ARDS (OR 2.73, 95% CI 1.13-6.58; p = 0.030).
Conclusion: Our study supports the value of HFOV in improving oxygenation and ventilation. Hemodynamic instability and sepsis are major contributors to worse short-term outcome in addition to the underlying diseases, mainly immune dysfunction and malignancies.