机构：[1]Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.[2]Saw Swee Hock School of Public Health, National University Health System, NUS Graduate School for Integrative Science and Engineering, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore.[3]Pediatric Intensive Care Unit, Children’s Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd, Yuzhong district, Chongqing 400041, China.[4]Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.[5]National Children’s Hospital, 18/879 La Thành, Láng Thư ng, Đ ng Đa, Hanoi, Vietnam.[6]Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok 10700, Thailand.[7]Beijing Children’s Hospital, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing 100045, China.首都医科大学附属北京儿童医院[8]Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.[9]Department of Pediatrics, University of Malaya. Jalan Universiti, 50603, Wilayah Persekutuan, Kuala Lumpur, Malaysia.[10]Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia.[11]Critical Care Excellence Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University Bangkok, Bangkok 10330, Thailand
High-frequency oscillatory ventilation (HFOV) use was associated with greater mortality in adult acute respiratory distress syndrome (ARDS). Nevertheless, HFOV is still frequently used as rescue therapy in paediatric acute respiratory distress syndrome (PARDS). In view of the limited evidence for HFOV in PARDS and evidence demonstrating harm in adult patients with ARDS, we hypothesized that HFOV use compared to other modes of mechanical ventilation is associated with increased mortality in PARDS.
Patients with PARDS from 10 paediatric intensive care units across Asia from 2009 to 2015 were identified. Data on epidemiology and clinical outcomes were collected. Patients on HFOV were compared to patients on other modes of ventilation. The primary outcome was 28-day mortality and secondary outcomes were 28-day ventilator- (VFD) and intensive care unit- (IFD) free days. Genetic matching (GM) method was used to analyse the association between HFOV treatment with the primary outcome. Additionally, we performed a sensitivity analysis, including propensity score (PS) matching, inverse probability of treatment weighting (IPTW) and marginal structural modelling (MSM) to estimate the treatment effect.
A total of 328 patients were included. In the first 7 days of PARDS, 122/328 (37.2%) patients were supported with HFOV. There were significant differences in baseline oxygenation index (OI) between the HFOV and non-HFOV groups (18.8 [12.0, 30.2] vs. 7.7 [5.1, 13.1] respectively; p < 0.001). A total of 118 pairs were matched in the GM method which found a significant association between HFOV with 28-day mortality in PARDS [odds ratio 2.3, 95% confidence interval (CI) 1.3, 4.4, p value 0.01]. VFD was indifferent between the HFOV and non-HFOV group [mean difference - 1.3 (95%CI - 3.4, 0.9); p = 0.29] but IFD was significantly lower in the HFOV group [- 2.5 (95%CI - 4.9, - 0.5); p = 0.03]. From the sensitivity analysis, PS matching, IPTW and MSM all showed consistent direction of HFOV treatment effect in PARDS.
The use of HFOV was associated with increased 28-day mortality in PARDS. This study suggests caution but does not eliminate equivocality and a randomized controlled trial is justified to examine the true association.
基金：
This study was funded by the Khoo Pilot Research Award Duke-NUS-KPA/
2016/0024 from the Estate of Tan Sri Khoo Teck Puat (Principal Investigator:
JJMW). This study was also partially supported by NUS start-up grant R-608-
000-172-133. SL was funded by the NUS Graduate School for Integrative Sciences
and Engineering Scholarship (NGSS).
第一作者机构：[1]Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
推荐引用方式(GB/T 7714)：
Wong Judith Ju-Ming,Liu Siqi,Dang Hongxing,et al.The impact of high frequency oscillatory ventilation on mortality in paediatric acute respiratory distress syndrome.[J].CRITICAL CARE.2020,24(1):31.doi:10.1186/s13054-020-2741-x.
APA：
Wong Judith Ju-Ming,Liu Siqi,Dang Hongxing,Anantasit Nattachai,Phan Phuc Huu...&the Pediatric Acute & Critical care Medicine Asian Network.(2020).The impact of high frequency oscillatory ventilation on mortality in paediatric acute respiratory distress syndrome..CRITICAL CARE,24,(1)
MLA：
Wong Judith Ju-Ming,et al."The impact of high frequency oscillatory ventilation on mortality in paediatric acute respiratory distress syndrome.".CRITICAL CARE 24..1(2020):31
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