Author Of 2 Presentations
AIRWAY PRESSURE RELEASE VENTILATION AS A RESCUE THERAPY IN PAEDIATRIC ARDS
Abstract
Background
Airway pressure release ventilation (APRV) is an inverse-ratio mode of ventilation which aims to maintain high mean airway pressures whilst minimising ventilator induced lung injury. APRV has been reported to be safe, well tolerated and in many cases improve haemodynamics.
Objectives
We aimed to identify if APRV has a role as a rescue therapy in paediatric ARDS to prevent escalation to HFOV.
Methods
Retrospective analysis of children with refractory hypoxaemia to conventional ventilation transitioned to APRV during period May 2014 - August 2018 at Nottingham Children’s Hospital, UK. Demographics, diagnosis, indication, PaO2/FiO2 (P/F ratio), mean duration of time on APRV, complications and outcomes were analysed.
Results
15 patients were identified; 4 were excluded. The mean age was 6.4 years (4 months – 17 years). On implementation of APRV, mean PaCO2 was 8.36 kPA and mean P/F ratio was 68, where a P/F ratio of <100 indicates severe ARDS. 72% of patients remained on APRV for <1 hour. One patient received nitric oxide whilst on APRV. Only 10% de-escalated from APRV due to improvement in clinical status. 63% escalated to HFOV or ECMO. No complications were reported.
Conclusion
Our results only identified one patient in our sample who improved when APRV was used as a rescue therapy. However, as there were no complications observed whilst utilising APRV, we suggest it is a safe mode of ventilation to trial in paediatric patients with severe ARDS.
THE PEAKS AND TROUGHS OF HIGH FREQUENCY OSCILLATORY VENTILATION (HFOV): PICU EXPERIENCE OVER 3 YEARS
Abstract
Background
Despite the lack of evidence of HFOV in ARDS in adult trials, this strategy is still a rescue therapy in children. Over the last three years, of the 2000 children Nottingham University Hospitals has ventilated , 2% were oscillated.
Objectives
We aimed to identify the indications, demographics, and outcomes of patients on HFOV.
Methods
Retrospective study of children ventilated on HFOV between January 2015-March 2018; demographics, diagnosis, indications and clinical data, adjuvants therapies and outcomes were analysed
Results
49 patients were identified; 16 excluded. The mean age was 2.2 +/- 3.5 years [DP(&YP1] (3 days- 18 years) with a mean LOS of 17.9 days. 70% of the patient had ARDS or viral pneumonitis and 60% had comorbidities (prematurity13%, neurodevelopment 13%, respiratory 11%, congenital heart disease 7%, haemato-oncology 7%).Before HFOV children were on Conventional Mechanical Ventilation for a mean of 47 hours; Oxygenation Index was 27.8 (7.3 -67.4); FiO2 85% (45-100), PaO2 9.1Kpa (3.6-19.1), PCO2 11.4Kpa (7.5-20), MAP 18 (26-12). The OI had a significant improvement after 12 (21.0+/- 14.1) and 24 (10.5 +/- 5.2) hours. The pH (7.27 +/- 0.1) and the pCO2 (8.9+/- 3.1) had a significant improvement 2 hours after HFOV. Nitric Oxide was used in 40% of the children; 5 patients were accepted for ECMO and 5 died (1 on ECMO).
Conclusion
Most patients presented with severe respiratory failure, mainly ARDS, have multiple comorbidities, with a survival rate of 93%. Oscillation was effective with improvement of the oxygenation and ventilation in this group of patients.