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Predictors of failure of high-frequency oscillatory ventilation in term infants with severe respiratory failure.
Pediatrics. 1995 Mar; 95(3):400-4.Ped

Abstract

OBJECTIVE

To identify clinical factors in term neonates with severe respiratory failure that predict which neonates are unlikely to respond to high-frequency oscillatory ventilation (HFOV).

DESIGN

This was a retrospective review of patient charts and medical records.

PATIENTS

We studied 190 newborns treated with HFOV between July 1985 and December 1992. All patients were at least 35 weeks' estimated gestational age and had severe respiratory failure, defined as arterial to alveolar oxygen ratio (a/A ratio) of less than 0.2 or the need for peak inspiratory pressure greater than 35 cm H2O on conventional ventilation.

RESULTS

Of the 190 patients, 111 (58%) responded to HFOV (HFOV responders), and 79 (42%) were placed on extracorporeal membrane oxygenation (ECMO) after HFOV failed to improve gas exchange (nonresponders). The two groups were similar in gender and birth weight. Factors associated with failure of HFOV to produce a sustained improvement in gas exchange were a diagnosis of congenital diaphragmatic hernia and more severe respiratory compromise as assessed by admission blood gas. Stepwise logistic regression analysis showed that a diagnosis of congenital diaphragmatic hernia/lung hypoplasia (CDH/LH) and the a/A ratio at initiation of and after 6 hours of HFOV were the only significant independent predictors of the need for ECMO. Among all the patients, the presence of CDH/LH or an initial a/A ratio of 0.05 or lower yielded a sensitivity of 74% and specificity of 77% in correctly identifying neonates in whom HFOV failed to produce a sustained improvement in oxygenation. When neonates with CDH/LH were excluded from analysis, the most significant predictor of failure of HFOV was the a/A ratio after 6 hours of HFOV. In neonates without CHD/LH, a 6-hour a/A ratio of 0.08 or lower discriminated responders from nonresponders (ie, treatment with ECMO) with a sensitivity of 77% and specificity of 92%.

CONCLUSIONS

In our patients, the presence of CDH/LH, severe respiratory failure (a/A ratio 0.05 or lower) at initiation of HFOV, and lack of improvement in oxygenation (a/A ratio 0.08 or lower after 6 hours of HFOV) were associated with failure of HFOV and treatment with ECMO. This information should help other centers to identify neonates who are at the greatest risk for requiring ECMO support and thus allow prompt transfer to an ECMO center.

Authors+Show Affiliations

Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7862480

Citation

Paranka, M S., et al. "Predictors of Failure of High-frequency Oscillatory Ventilation in Term Infants With Severe Respiratory Failure." Pediatrics, vol. 95, no. 3, 1995, pp. 400-4.
Paranka MS, Clark RH, Yoder BA, et al. Predictors of failure of high-frequency oscillatory ventilation in term infants with severe respiratory failure. Pediatrics. 1995;95(3):400-4.
Paranka, M. S., Clark, R. H., Yoder, B. A., & Null, D. M. (1995). Predictors of failure of high-frequency oscillatory ventilation in term infants with severe respiratory failure. Pediatrics, 95(3), 400-4.
Paranka MS, et al. Predictors of Failure of High-frequency Oscillatory Ventilation in Term Infants With Severe Respiratory Failure. Pediatrics. 1995;95(3):400-4. PubMed PMID: 7862480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of failure of high-frequency oscillatory ventilation in term infants with severe respiratory failure. AU - Paranka,M S, AU - Clark,R H, AU - Yoder,B A, AU - Null,D M,Jr PY - 1995/3/1/pubmed PY - 2001/3/28/medline PY - 1995/3/1/entrez SP - 400 EP - 4 JF - Pediatrics JO - Pediatrics VL - 95 IS - 3 N2 - OBJECTIVE: To identify clinical factors in term neonates with severe respiratory failure that predict which neonates are unlikely to respond to high-frequency oscillatory ventilation (HFOV). DESIGN: This was a retrospective review of patient charts and medical records. PATIENTS: We studied 190 newborns treated with HFOV between July 1985 and December 1992. All patients were at least 35 weeks' estimated gestational age and had severe respiratory failure, defined as arterial to alveolar oxygen ratio (a/A ratio) of less than 0.2 or the need for peak inspiratory pressure greater than 35 cm H2O on conventional ventilation. RESULTS: Of the 190 patients, 111 (58%) responded to HFOV (HFOV responders), and 79 (42%) were placed on extracorporeal membrane oxygenation (ECMO) after HFOV failed to improve gas exchange (nonresponders). The two groups were similar in gender and birth weight. Factors associated with failure of HFOV to produce a sustained improvement in gas exchange were a diagnosis of congenital diaphragmatic hernia and more severe respiratory compromise as assessed by admission blood gas. Stepwise logistic regression analysis showed that a diagnosis of congenital diaphragmatic hernia/lung hypoplasia (CDH/LH) and the a/A ratio at initiation of and after 6 hours of HFOV were the only significant independent predictors of the need for ECMO. Among all the patients, the presence of CDH/LH or an initial a/A ratio of 0.05 or lower yielded a sensitivity of 74% and specificity of 77% in correctly identifying neonates in whom HFOV failed to produce a sustained improvement in oxygenation. When neonates with CDH/LH were excluded from analysis, the most significant predictor of failure of HFOV was the a/A ratio after 6 hours of HFOV. In neonates without CHD/LH, a 6-hour a/A ratio of 0.08 or lower discriminated responders from nonresponders (ie, treatment with ECMO) with a sensitivity of 77% and specificity of 92%. CONCLUSIONS: In our patients, the presence of CDH/LH, severe respiratory failure (a/A ratio 0.05 or lower) at initiation of HFOV, and lack of improvement in oxygenation (a/A ratio 0.08 or lower after 6 hours of HFOV) were associated with failure of HFOV and treatment with ECMO. This information should help other centers to identify neonates who are at the greatest risk for requiring ECMO support and thus allow prompt transfer to an ECMO center. SN - 0031-4005 UR - https://www.unboundmedicine.com/medline/citation/7862480/Predictors_of_failure_of_high_frequency_oscillatory_ventilation_in_term_infants_with_severe_respiratory_failure_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=7862480 DB - PRIME DP - Unbound Medicine ER -