High-frequency oscillatory ventilation use and severe pediatric ards in the pediatric hematopoietic cell transplant recipient

The Investigators of the Pediatric Acute Lung Injury and Sepsis Network

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

INTRODUCTION: The effectiveness of high-frequency oscillatory ventilation (HFOV) in the pediatric hematopoietic cell transplant patient has not been established. We sought to identify current practice patterns of HFOV, investigate parameters during HFOV and their association with mortality, and compare the use of HFOV to conventional mechanical ventilation in severe pediatric ARDS. METHODS: This is a retrospective analysis of a multi-center database of pediatric and young adult allogeneic hematopoietic cell transplant subjects requiring invasive mechanical ventilation for critical illness from 2009 through 2014. Twelve United States pediatric centers contributed data. Continuous variables were compared using a Wilcoxon rank-sum test or a Kruskal-Wallis analysis. For categorical variables, univariate analysis with logistic regression was performed. RESULTS: The database contains 222 patients, of which 85 subjects were managed with HFOV. Of this HFOV cohort, the overall pediatric ICU survival was 23.5% (n = 20). HFOV survivors were transitioned to HFOV at a lower oxygenation index than nonsurvivors (25.6, interquartile range 21.1–36.8, vs 37.2, interquartile range 26.5–52.2, P = .046). Survivors were transitioned to HFOV earlier in the course of mechanical ventilation, (day 0 vs day 2, P = .002). No subject survived who was transitioned to HFOV after 1 week of invasive mechanical ventilation. We compared subjects with severe pediatric ARDS treated only with conventional mechanical ventilation versus early HFOV (within 2 d of invasive mechanical ventilation) versus late HFOV. There was a trend toward difference in survival (conventional mechanical ventilation 24%, early HFOV 30%, and late HFOV 9%, P = .08). CONCLUSIONS: In this large database of pediatric allogeneic hematopoietic cell transplant subjects who had acute respiratory failure requiring invasive mechanical ventilation for critical illness with severe pediatric ARDS, early use of HFOV was associated with improved survival compared to late implementation of HFOV, and the subjects had outcomes similar to those treated only with conventional mechanical ventilation. Key words: hematopoietic stem cell transplantation; critical care; respiratory insufficiency; artificial respiration; high frequency ventilation; mortality; respiratory distress syndrome; adult. [Respir Care 2018;63(4):404–411.

Original languageEnglish (US)
Pages (from-to)404-411
Number of pages8
JournalRespiratory Care
Volume63
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

High-Frequency Ventilation
Pediatrics
Transplants
Artificial Respiration
Transplant Recipients
Databases
Nonparametric Statistics
Critical Illness
Respiratory Insufficiency
Survival
Survivors
Mortality

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

High-frequency oscillatory ventilation use and severe pediatric ards in the pediatric hematopoietic cell transplant recipient. / The Investigators of the Pediatric Acute Lung Injury and Sepsis Network.

In: Respiratory Care, Vol. 63, No. 4, 01.04.2018, p. 404-411.

Research output: Contribution to journalArticle

The Investigators of the Pediatric Acute Lung Injury and Sepsis Network. / High-frequency oscillatory ventilation use and severe pediatric ards in the pediatric hematopoietic cell transplant recipient. In: Respiratory Care. 2018 ; Vol. 63, No. 4. pp. 404-411.
@article{fd4eb3afb2a047a69a06b55102a41ba5,
title = "High-frequency oscillatory ventilation use and severe pediatric ards in the pediatric hematopoietic cell transplant recipient",
abstract = "INTRODUCTION: The effectiveness of high-frequency oscillatory ventilation (HFOV) in the pediatric hematopoietic cell transplant patient has not been established. We sought to identify current practice patterns of HFOV, investigate parameters during HFOV and their association with mortality, and compare the use of HFOV to conventional mechanical ventilation in severe pediatric ARDS. METHODS: This is a retrospective analysis of a multi-center database of pediatric and young adult allogeneic hematopoietic cell transplant subjects requiring invasive mechanical ventilation for critical illness from 2009 through 2014. Twelve United States pediatric centers contributed data. Continuous variables were compared using a Wilcoxon rank-sum test or a Kruskal-Wallis analysis. For categorical variables, univariate analysis with logistic regression was performed. RESULTS: The database contains 222 patients, of which 85 subjects were managed with HFOV. Of this HFOV cohort, the overall pediatric ICU survival was 23.5{\%} (n = 20). HFOV survivors were transitioned to HFOV at a lower oxygenation index than nonsurvivors (25.6, interquartile range 21.1–36.8, vs 37.2, interquartile range 26.5–52.2, P = .046). Survivors were transitioned to HFOV earlier in the course of mechanical ventilation, (day 0 vs day 2, P = .002). No subject survived who was transitioned to HFOV after 1 week of invasive mechanical ventilation. We compared subjects with severe pediatric ARDS treated only with conventional mechanical ventilation versus early HFOV (within 2 d of invasive mechanical ventilation) versus late HFOV. There was a trend toward difference in survival (conventional mechanical ventilation 24{\%}, early HFOV 30{\%}, and late HFOV 9{\%}, P = .08). CONCLUSIONS: In this large database of pediatric allogeneic hematopoietic cell transplant subjects who had acute respiratory failure requiring invasive mechanical ventilation for critical illness with severe pediatric ARDS, early use of HFOV was associated with improved survival compared to late implementation of HFOV, and the subjects had outcomes similar to those treated only with conventional mechanical ventilation. Key words: hematopoietic stem cell transplantation; critical care; respiratory insufficiency; artificial respiration; high frequency ventilation; mortality; respiratory distress syndrome; adult. [Respir Care 2018;63(4):404–411.",
author = "{The Investigators of the Pediatric Acute Lung Injury and Sepsis Network} and Rowan, {Courtney M.} and Ashley Loomis and Jennifer McArthur and Smith, {Lincoln S.} and Gertz, {Shira J.} and Fitzgerald, {Julie C.} and Mara Nitu and Moser, {Elizabeth A.S.} and Hsing, {Deyin D.} and Duncan, {Christine N.} and Mahadeo, {Kris M.} and Jerelyn Moffet and Hall, {Mark W.} and Pinos, {Emily L.} and Tamburro, {Robert F.} and Cheifetz, {Ira M.}",
year = "2018",
month = "4",
day = "1",
doi = "10.4187/respcare.05765",
language = "English (US)",
volume = "63",
pages = "404--411",
journal = "Respiratory Care",
issn = "0020-1324",
publisher = "Daedalus Enterprises Inc.",
number = "4",

}

TY - JOUR

T1 - High-frequency oscillatory ventilation use and severe pediatric ards in the pediatric hematopoietic cell transplant recipient

AU - The Investigators of the Pediatric Acute Lung Injury and Sepsis Network

AU - Rowan, Courtney M.

AU - Loomis, Ashley

AU - McArthur, Jennifer

AU - Smith, Lincoln S.

AU - Gertz, Shira J.

AU - Fitzgerald, Julie C.

AU - Nitu, Mara

AU - Moser, Elizabeth A.S.

AU - Hsing, Deyin D.

AU - Duncan, Christine N.

AU - Mahadeo, Kris M.

AU - Moffet, Jerelyn

AU - Hall, Mark W.

AU - Pinos, Emily L.

AU - Tamburro, Robert F.

AU - Cheifetz, Ira M.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - INTRODUCTION: The effectiveness of high-frequency oscillatory ventilation (HFOV) in the pediatric hematopoietic cell transplant patient has not been established. We sought to identify current practice patterns of HFOV, investigate parameters during HFOV and their association with mortality, and compare the use of HFOV to conventional mechanical ventilation in severe pediatric ARDS. METHODS: This is a retrospective analysis of a multi-center database of pediatric and young adult allogeneic hematopoietic cell transplant subjects requiring invasive mechanical ventilation for critical illness from 2009 through 2014. Twelve United States pediatric centers contributed data. Continuous variables were compared using a Wilcoxon rank-sum test or a Kruskal-Wallis analysis. For categorical variables, univariate analysis with logistic regression was performed. RESULTS: The database contains 222 patients, of which 85 subjects were managed with HFOV. Of this HFOV cohort, the overall pediatric ICU survival was 23.5% (n = 20). HFOV survivors were transitioned to HFOV at a lower oxygenation index than nonsurvivors (25.6, interquartile range 21.1–36.8, vs 37.2, interquartile range 26.5–52.2, P = .046). Survivors were transitioned to HFOV earlier in the course of mechanical ventilation, (day 0 vs day 2, P = .002). No subject survived who was transitioned to HFOV after 1 week of invasive mechanical ventilation. We compared subjects with severe pediatric ARDS treated only with conventional mechanical ventilation versus early HFOV (within 2 d of invasive mechanical ventilation) versus late HFOV. There was a trend toward difference in survival (conventional mechanical ventilation 24%, early HFOV 30%, and late HFOV 9%, P = .08). CONCLUSIONS: In this large database of pediatric allogeneic hematopoietic cell transplant subjects who had acute respiratory failure requiring invasive mechanical ventilation for critical illness with severe pediatric ARDS, early use of HFOV was associated with improved survival compared to late implementation of HFOV, and the subjects had outcomes similar to those treated only with conventional mechanical ventilation. Key words: hematopoietic stem cell transplantation; critical care; respiratory insufficiency; artificial respiration; high frequency ventilation; mortality; respiratory distress syndrome; adult. [Respir Care 2018;63(4):404–411.

AB - INTRODUCTION: The effectiveness of high-frequency oscillatory ventilation (HFOV) in the pediatric hematopoietic cell transplant patient has not been established. We sought to identify current practice patterns of HFOV, investigate parameters during HFOV and their association with mortality, and compare the use of HFOV to conventional mechanical ventilation in severe pediatric ARDS. METHODS: This is a retrospective analysis of a multi-center database of pediatric and young adult allogeneic hematopoietic cell transplant subjects requiring invasive mechanical ventilation for critical illness from 2009 through 2014. Twelve United States pediatric centers contributed data. Continuous variables were compared using a Wilcoxon rank-sum test or a Kruskal-Wallis analysis. For categorical variables, univariate analysis with logistic regression was performed. RESULTS: The database contains 222 patients, of which 85 subjects were managed with HFOV. Of this HFOV cohort, the overall pediatric ICU survival was 23.5% (n = 20). HFOV survivors were transitioned to HFOV at a lower oxygenation index than nonsurvivors (25.6, interquartile range 21.1–36.8, vs 37.2, interquartile range 26.5–52.2, P = .046). Survivors were transitioned to HFOV earlier in the course of mechanical ventilation, (day 0 vs day 2, P = .002). No subject survived who was transitioned to HFOV after 1 week of invasive mechanical ventilation. We compared subjects with severe pediatric ARDS treated only with conventional mechanical ventilation versus early HFOV (within 2 d of invasive mechanical ventilation) versus late HFOV. There was a trend toward difference in survival (conventional mechanical ventilation 24%, early HFOV 30%, and late HFOV 9%, P = .08). CONCLUSIONS: In this large database of pediatric allogeneic hematopoietic cell transplant subjects who had acute respiratory failure requiring invasive mechanical ventilation for critical illness with severe pediatric ARDS, early use of HFOV was associated with improved survival compared to late implementation of HFOV, and the subjects had outcomes similar to those treated only with conventional mechanical ventilation. Key words: hematopoietic stem cell transplantation; critical care; respiratory insufficiency; artificial respiration; high frequency ventilation; mortality; respiratory distress syndrome; adult. [Respir Care 2018;63(4):404–411.

UR - http://www.scopus.com/inward/record.url?scp=85046121640&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046121640&partnerID=8YFLogxK

U2 - 10.4187/respcare.05765

DO - 10.4187/respcare.05765

M3 - Article

C2 - 29279362

AN - SCOPUS:85046121640

VL - 63

SP - 404

EP - 411

JO - Respiratory Care

JF - Respiratory Care

SN - 0020-1324

IS - 4

ER -