Ahmed EL NAWAWY, Azza MOUSTAFA, Hassan HESHMAT, Ahmed ABOUAHMED

High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study

The aim of this prospective randomized study is to compare the outcomesof the early use of either high frequency oscillation (HFO) or conventionalmechanical ventilation (CMV) in patients with pediatric acute respiratorydistress syndrome (PARDS). We allocated two hundred PARDS patients over5 years in 1:1 ratio to either mode. The HFO group showed a significantlyhigher median partial arterial oxygen pressure to fraction of inspired oxygen(PaO2/FiO2) values after 24 hours of enrollment (p=0.011), higher oxygenationindex (OI) decrease percent (p=0.004) and lower cross-over rates (p8.5, ≤139 respectively). PARDS patients with baseline OI> 16 hada better chance of survival if initially ventilated with the HFO (p=0.004).Although the HFO mode appeared to be a safe mode with a significantbetter oxygenation improvement (after the first 24 hours) and fewer crossover rates, it failed to show differences as regards mortality or LOS whencompared to the CMV adopting protective lung strategy. In PARDS, HFOhad a superior advantage in improving oxygenation, yet with no significantmortality improvement, as multi-organ dysfunction syndrome (MODS) wasthe most common cause of death in our study and not refractory hypoxemiawhich is the main problem in PARDS; highlighting that mortality in PARDSis multi-factorial and may not depend only on how fast oxygenation improves.

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