(1189) High-Frequency Percussive Ventilation in Pediatric Acute Respiratory Failure in a Tertiary PICU

Introduction: High-frequency percussive ventilation (HFPV) is an alternative mode of mechanical ventilation that shows promise in improving gas exchange and secretion clearance in pediatric acute respiratory failure (ARF). Despite its potential, HFPV is not well-documented in the context of pediatric ARF. This study aimed to describe children's clinical characteristics and outcomes on HFPV at a tertiary pediatric intensive care unit.

Methods: This IRB-approved single-center retrospective cohort study included intubated patients who received HFPV for ≥ 6 hours between 2018 and 2023. HFPV failure was defined as either death or transfer to another institution for a higher level of cardiopulmonary support. Oxygenation indices, PCO2, and hemodynamic parameters were analyzed 2 hours before and 2, 4, 12, 24, and 48 hours after starting HFPV. Patient demographics, gas exchange metrics, and ventilator parameters were compared between successful and failed groups using chi-square, Mann-Whitney U tests, and ROC analysis.

Results: Of 33 patients managed on HFPV, 32 met the inclusion criteria. The median age was 60 months (IQR 4–171), and the median PIM-3 score was 1.8% (IQR 0.5 – 4.7). There were 10 failures (31%), consisting of 6 non-survivors (19%) and 4 transfers to a higher level of care (12.5%). Baseline values of oxygenation indices (SF and OSI), PCO2, and hemodynamic parameters (HR and MAP) were similar in successful and failed groups. Compared to baseline values, the OSI improved at 4 hours (2.5 (-6.2 to 5.7) vs -4.8 (-11.7 to -1); p=0.009) and the SF ratio improved at 12 hours (-56 (-88 to -21) vs -12 (-49 to 10); p=0.04) after starting HFPV in the successful group compared to the failed group. ROC analysis showed an AUC of 0.83 (95% CI: 0.68-0.99; p=0.008) for a change in OSI baseline to 4 hours to discriminate the success and failure of HFPV. Although there was an overall improvement in pCO2 values, there was no significant difference between the success and failure groups. Hemodynamic parameters improved in the successful group within 48 hrs (p=0.02).

Conclusions: Improvement in oxygenation indices within 4-12 hours after starting HFPV can predict if this modality will succeed. These findings need to be confirmed in a large study and are helpful for clinical practice implementation.