Effectiveness of Continuous High-Frequency Oscillation Therapy for Lung Recruitment in Pediatric Critical Care Patients

Abstract

Background: Continuous high-frequency oscillation therapy (CHFO) delivers rapid sub-tidal-volume bursts of gas during spontaneous and assisted ventilation, increasing mean airway pressure, dilating distal airways, and facilitating airway clearance. Use of CHFO has demonstrated improved radiologic findings following one day of therapy. We sought to identify whether CHFO is effective in intubated patients with documented atelectasis. We hypothesize CHFO use is associated with decreased atelectasis and ventilation parameters. Methods: A respective analysis of intubated patients from the cardiac or pediatric intensive care units receiving CHFO between January 2015 and February 2018. Differences determined by χ2 analyses expressed as (n, %) for categorical data and Mann-Whitney Rank Sum Test for continuous variables presented as Median [interquartile range]. Chest x-rays were graded using a scale from -1 (worsening), 0 (unchanged), and 1 (improved atelectasis). Overall and unit specific rates of improvement were compared using radiographic reports prior to, first, and second-day post CHFO therapy. Deterioration was combined with no change group then evaluated for improvement following 1 then 2 days of CHFO. Results: One hundred four patients were included in the study. Cardiac intensive care patients were, younger, had higher incidence of surgery, inhaled nitric oxide, higher set respiratory rates, and lower saturations (Table 1). Ninety patients (86%) had chest radiographs categorized as worsening or unchanged prior to CHFO therapy. The cohort had a 46.1% (41/89; P < .05) therapy response rate after day one and an additional 28.8% (10/48; NS) response rate in the group that did not demonstrate response after 1-day of therapy. No Difference was found between ICU groups, ventilator or blood gas measures. Conclusions: Continuous High-Frequency Oscillation Therapy was effective in treating atelectasis in intubated infants and children with documented atelectasis. Not response rate differences were found regarding ventilator settings or response rates in all-comers and between CICU and PICU. More study is needed to identify the longitudinal outcome benefits in the pediatric population.

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