Use of High Frequency Percussive Ventilation as an Alternative Ventilation Strategy in ELGANs

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ESPR205
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Background: High frequency percussive ventilation (HFPV) is a more versatile form of high frequency ventilation that allows high-frequency breaths to be superimposed upon conventional ventilation. It is often used as a rescue strategy in severe lung disease unresponsive to maximal conventional support with repeated areas of alveolar collapse secondary to increased airway secretions in an effort to combine the benefits of both conventional and high frequency ventilation while reducing any associated damage. We retrospectively reviewed ELGAN neonates who failed multiple ventilator strategies for improvement upon trial of HFPV.


Objective: To evaluate the use of HFPV as an alternate ventilation strategy in the ELGAN population


Design/Methods: Retrospective review of ELGAN infants who required HFPV due to severe lung disease. Alternative ventilator strategies, settings, and demographics were recorded. Respiratory severity scores (RSS) were also calculated for each infant


Results: 13 infants with an average gestational age of 25.1 (1.5) [mean (SD)] weeks and birth weight of 665 (157) grams were evaluated. All infants were trialed on multiple ventilator methods with no improvement in their severe lung disease prior to being transitioned to HFPV. Of the 13 infants, 9 survived and 4 did not. Of the infants who survived, the RSS prior to being placed on the HFPV was 12.4 (9.9) which decreased to 6 (4.6, 13.2) [median (IQR)] after the change. For the four infants who died the RSS was 11.3 (2.5) with a smaller RSS decrease to 9.5 (5.1, 13) following the switch to HFPV. Chest x-rays were also reviewed prior and after being switched to HFPV with most significant improvement in areas of atelectasis and aeration in those surviving.


Conclusion(s): For the infants who survived there was a dramatic improvement in RSS due to an improvement in oxygenation following placement on HFPV. We speculate that this may be due to increased recruitment following HFPV. The infants who died did not show as dramatic a reduction in RSS as compared to those who survived. For several of the infants, mucus plugging was believed to be a major component of their respiratory complications. HFPV has been previously shown to be effective in aiding mucociliary clearance of secretions partially through increased humidification. During our observations, increased endotracheal tube suctioning was required to remove mobilized secretions following placement on HFPV. This may explain improvement-both clinical, as well as radiographical- which we propose was primarily due to mucous plugging. For infants with difficulties in oxygenation and ventilation-who are already on HFJV or HFOV-a trial of HFPV may be a reasonable therapeutic intervention.

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Westchester Medical Center
Westchester Medical Center
The Regional Neonatal ICU, Maria Fareri Children’s Hospital at Westchester Medical Center, NYMC, Valhalla, NY, US

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