NON-CONVENTIONAL RESPIRATORY SUPPORT MODALITIES APPLICABLE IN THE OLDER CHILD : High Frequency Ventilation and Liquid Ventilation - 09/09/11

Doi : 10.1016/S0749-0704(05)70025-7

Harry J. Kallas, MD ^{^{*
Department of Pediatrics, University of California, Davis, School of Medicine, and University of California, Davis, Medical Center, Sacramento, California}}

Résumé

Acute respiratory failure (ARF) continues to be the leading reason for pediatric intensive care unit (PICU) admission. Despite optimal management, death from respiratory failure continues to occur in patients who have severe aberrations in lung function. For example, mortality for acute respiratory distress syndrome (ARDS) in children has continued to be high (>50%).^{21 Beaufils F., Mercier J.C., Farnoux C. , et al. Acute respiratory distress syndrome in children Curr Opin Pediatr 1997 ; 9 : 207-212 [cross-ref]

Cliquez ici pour aller à la section Références} A myriad of innovative therapies are increasingly being utilized in attempts to improve patient outcome.^{169 Paulson T.E., Spear R.M., Peterson B.M. New concepts in the treatment of children with acute respiratory distress syndrome J Pediatr 1995 ; 127 : 163-175 [cross-ref]

Cliquez ici pour aller à la section Références} Many of these therapies were developed for pediatric patients or have achieved greater success and clinical application in critically ill children. Artificial surfactant is one such example that has revolutionized the field of neonatology. Inhaled nitric oxide (iNO) appears to be having a significant effect in many children who have congenital heart disease, persistent pulmonary hypertension of the newborn (PPHN), and congenital diaphragmatic hernia (CDH). Various methods of high-frequency ventilation (HFV) may improve the condition of some children who have respiratory failure and potentially decrease the number of children subjected to extracorporeal life support (ECLS). There are now well over 11,000 infants and 2,000 children who have received ECLS for severe cardiorespiratory failure with an overall survival in excess of 60%^{5 The Neonatal ECMO Registry of the Extracorporeal Life Support Organization. Ann Arbor, MI, 1995

Cliquez ici pour aller à la section Références}; this technology, almost forgotten for two decades in adult intensive care, is again receiving attention in adults. Liquid ventilation (LV), an experimental method of respiratory support in which the subject's lungs are filled with a liquid perfluorochemical (PFC), was first applied in infants^{84 Greenspan J.S., Wolfson M.R., Rubenstein S.D. , et al. Liquid ventilation of preterm baby Lancet 1989 ; 2 : 1095 [cross-ref]

Cliquez ici pour aller à la section Références} and has thus far been employed in many more children than adult subjects. Despite this cornucopia of new therapies, few controlled trials have been conducted to guide the practitioner regarding the indications and the efficacy of these various modalities. Controversy has sparked several international consensus statements to form a framework for future discussion and investigation.^{3 American Association of Respiratory Care Consensus statement on the essentials of mechanical ventilators Respir Care 1992 ; 37 : 1000

Cliquez ici pour aller à la section Références, 205 Slutsky A.S. Mechanical ventilation. American College of Chest Physicians Consensus Conference Chest 1993 ; 104 : 1833 [cross-ref]

Cliquez ici pour aller à la section Références, 243 Wright L.L. Report of the workshop on diffusion of ECMO technology Rockville, MD: NIH Publication No. 93-3399 (1993).
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Cliquez ici pour aller à la section Références} This article focuses on two of these novel modalities: HFV and LV.

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Plan

Address reprint requests to Harry J. Kallas, MD, Department of Pediatrics, University of California, Davis, 2516 Stockton Blvd., Ticon II, Sacramento, CA 95817, e-mail: hjkallas@ucdavis.edu