Predicting outcome in children with severe acute respiratory failure treated with high-frequency ventilation

OBJECTIVESa) To demonstrate the effect of high-frequency ventilation on gas exchange in children with severe acute respiratory failure unresponsive to conventional ventilation; b) to identify patients at high risk of death early after institution of high-frequency ventilation. SETTINGTertiary care pediatric intensive care unit in a university hospital. DESIGNA cross-sectional, observational study with factorial design. PATIENTSThirty-one patients with severe acute respiratory failure defined as a PaO2/FIO2 of 60 torr (>8 kPa) with an arterial pH 20 and failure to decrease the oxygenation index by >20% by 6 hrs after initiation of high-frequency ventilation predicted death with 88% (7/8) sensitivity and 83% (19/23) specificity, with an odds ratio of 33 (p = .0036, 95% confidence interval 3-365). CONCLUSIONSIn patients with potentially reversible underlying diseases resulting in severe acute respiratory failure that is unresponsive to conventional ventilation, high-frequency ventilation improves gas exchange in a rapid and sustained fashion. The magnitude of impaired oxygenation and its improvement after high-frequency ventilation can predict outcome within 6 hrs.(Crit Care Med 1996; 24:1396-1402)