Document Detail


High-frequency oscillatory ventilation associated with inhaled nitric oxide compared to pressure-controlled assist/control ventilation and inhaled nitric oxide in children: Randomized, non-blinded, crossover study.
MedLine Citation:
PMID:  21520432     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare the acute oxygenation effects of high-frequency oscillatory ventilation (HFOV) plus inhaled nitric oxide (iNO) with pressure-controlled assist/control ventilation (PCACV) plus iNO in acute hypoxemic respiratory failure (AHRF) children.
METHODS: Children with AHRF, aged between 1 month and 14 years under PCACV with PEEP ≥ 10 cmH(2) O were randomly assigned to PCACV (PCVG, n = 14) or HFOV (HFVG, n = 14) in a crossover design. Oxygenation indexes and hemodynamic variables were recorded at enrollment (Tind), 1 hr after PCACV start (T0) and then every 4 hr (T4h, etc.).
RESULTS: PO(2)/FiO(2) significantly increased after 4 hr compared to enrollment in both groups [(PCVG-Tind: 111.95 ± 37 < T4h: 143.88 ± 47.5 mmHg, P < 0.05; HFVG-Tind: 123.76 ± 33 < T4h: 194.61 ± 62.42 mmHg, P < 0.05)] without any statistical differences between groups. At T8h, PO(2)/FiO(2) was greater for HFVG compared with PCVG (HFVG: 227.9 ± 80.7 > PCVG: 171.21 ± 52.9 mmHg, P < 0.05). FiO(2) could be significantly reduced after 4 hr for HFVG (HFVG-T4h: 0.53 ± 0.09 < Tind: 0.64 ± 0.2; P < 0.05) but only after 8 hr for PCVG. Comparing groups at T8h, it was observed that FiO(2) decrease was greater for HFVG (HFVG: 0.47 ± 0.06 < PCVG: 0.58 ± 0.1; P < 0.05).
CONCLUSION: Both ventilatory techniques with iNO improve oxygenation. HFOV causes earlier FiO(2) reduction and increased PO(2)/FiO(2) ratio compared to PCACV at 8 hr. However, at the end of the protocol, there was no significant difference and no clinical improvement derived from the application of both ventilatory strategies with iNO. It is not possible to say what would have happened if a different conventional ventilatory mode and a fully protective ventilatory strategy had been used, given the fact that our study is non-blind, and that a limited number of patients were included in each group.
Authors:
Jose Roberto Fioretto; Khristiani Almeida Batista; Mario Ferreira Carpi; Rossano Cesar Bonatto; Marcos Aurélio Moraes; Sandra Mara Queiroz Ricchetti; Rafaelle Fernandes Batistella
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-04-25
Journal Detail:
Title:  Pediatric pulmonology     Volume:  46     ISSN:  1099-0496     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-13     Completed Date:  2011-11-21     Revised Date:  2011-12-20    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  809-16     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Wiley-Liss, Inc.
Affiliation:
Pediatrics Department, Botucatu Medical School, Sao Paulo State University-UNESP, Sao Paulo, Brazil. jrf@fmb.unesp.br
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Cross-Over Studies
Female
High-Frequency Ventilation*
Humans
Infant
Male
Nitric Oxide / administration & dosage*
Oxygen / blood
Respiratory Insufficiency / therapy
Chemical
Reg. No./Substance:
10102-43-9/Nitric Oxide; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Pediatr Pulmonol. 2011 Dec;46(12):1251-2; author reply 1253-4   [PMID:  21815277 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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