Ventilación de alta frecuencia oscilatoria en pacientes pediátricos. Protocolo de aplicación y resultados preliminaries
High-frequency oscillatory ventilation in pediatric patients. protocol and preliminary results
F. Martinón Torresa,
, A. Rodríguez Núñeza, D.G. Jaimovichb, J.M. Martinón Sáncheza
Autor para correspondencia
fedemartinon@hotmail.com
Correspondencia: Dr. F. Martinón Torres. UCI Pediatría. Hospital Clínico Universitario de Santiago de Compostela. A Choupana, s/n. 15706 Santiago de Compostela.
Correspondencia: Dr. F. Martinón Torres. UCI Pediatría. Hospital Clínico Universitario de Santiago de Compostela. A Choupana, s/n. 15706 Santiago de Compostela.
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Protocolo de aplicación y resultados preliminaries" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "305" "paginaFinal" => "313" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Martinón Torres, A. Rodríguez Núñez, D.G. Jaimovich, J.M. Martinón Sánchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Martinón Torres" "email" => array:1 [ 0 => "fedemartinon@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Rodríguez Núñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "D.G." "apellidos" => "Jaimovich" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Martinón Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Críticos y Urgencias Pediátricas. Hospital Clínico Universitario de Santiago de Compostela." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pediatric Critical Care Division. Hope Children’s Hospital. Chicago. Illinois" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Dr. F. Martinón Torres. UCI Pediatría. Hospital Clínico Universitario de Santiago de Compostela. A Choupana, s/n. 15706 Santiago de Compostela." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "High-frequency oscillatory ventilation in pediatric patients. protocol and preliminary results" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-05-31" "fechaAceptado" => "2000-06-30" "PalabrasClave" => array:1 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186475" "palabras" => array:7 [ 0 => "Ventilación de alta frecuencia oscilatoria" 1 => "Síndrome de distrés respiratorio agudo" 2 => "Insuficiencia respiratoria aguda" 3 => "Ventilación mecánica" 4 => "Intercambio gaseoso pulmonar" 5 => "Unidades de cuidados intensivos pediátricos" 6 => "Niños" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec186476" "palabras" => array:7 [ 0 => "High-frequency ventilation" 1 => "Lung diseases" 2 => "Pulmonary gas exchange" 3 => "Pediatric intensive care units" 4 => "Respiratory distress syndrome" 5 => "Respiratory insufficiency" 6 => "Children" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La ventilación de alta frecuencia oscilatoria (VAFO) constituye un avance significativo en el manejo de niños con enfermedades respiratorias críticas. Aunque utilizada fundamentalmente como técnica de "rescate pulmonar", las indicaciones pediátricas de la VAFO pueden ser más amplias. Sus ventajas fundamentales sobre la ventilación convencional son la menor incidencia de barotrauma, volutrauma, atelectrauma y biotrauma. La experiencia con VAFO en nuestro país es escasa y limitada a pacientes neonatales.</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentar el protocolo de VAFO y analizar los resultados preliminares de su aplicación prospectiva</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se estableció un protocolo de aplicación de VAFO con los siguientes criterios de inclusión: insuficiencia respiratoria grave de cualquier etiología (infecciosa, inhalatoria, etc.) con un índice de oxigenación superior a 13 en dos muestras arteriales con un intervalo de 6 h, síndrome de distrés respiratorio agudo (SDRA) refractario, infección pulmonar grave por virus respiratorio sincitial y síndromes de amplio escape aéreo (neumotórax, neumoperitoneo, neumomediastino, etc.). Se recogieron los parámetros ventilatorios, gasométricos y hemodinámicos en modalidad convencional y en VAFO en los pacientes a los que se aplicó durante un período de 5 meses, y se analizaron las primeras 24 h.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se aplicó la VAFO a 6 pacientes de edades comprendidas entre 3 días y 8 años, conpesos comprendidos entre 4 y 80 kg. Su indicación fue la presencia de SDRA refractario en todos los casos. El índice de oxigenación medio pretratamiento fue de 45,9. Tras una hora de VAFO, este índice presentó un valor medio de 23,9. La mejoría progresiva del índice de oxigenación se mantenía a las 24 h. En todos los casos se consiguieron valores normales de PCO2 y fue posible disminuir la FiO2 por debajo de 0,6 antes de las 3 h de tratamiento. No se detectaron efectos adversos relacionados con la VAFO. La evolución clínica global fue satisfactoria en 2 casos, mientras que los otros cuatro fallecieron por fracaso multiorgánico.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La VAFO constituye una clara opción para el soporte ventilatorio de niños en estado crítico en los que las modalidades convencionales no resultan eficaces. Para obtener los mejores resultados, debería utilizarse de forma precoz. Todo niño con fracaso respiratorio refractario subsidiario de VAFO debe ser trasladado lo más pronto posible a un centro que disponga de esta técnica</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">High-frequency oscillatory ventilation (HFOV) constitutes an important advance in the management of children with respiratory failure. Although it has been used mainly as "lung rescue therapy", pediatric indications for HFOV can be broader. The principal advantages of this modality compared with conventional ventilation are the lower incidence of barotrauma, volutrauma, atelectrauma and biotrauma. To date, experience with HFOV in our country has been scarce and limited to neonatal patients</p> <span class="elsevierStyleSectionTitle">Objetives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To describe the HFOV protocol for pediatric patients and to report the preliminary results of its prospective application.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">An HFOV protocol was established with the following inclusion criteria: severe respiratory insufficiency of any origin (infectious, inhalatory, etc.) with an oxygenation index (OI) > 13 in two arterial blood gases within a 6hour interval, refractory acute respiratory distress syndrome (ARDS), severe respiratory syncytial virus pneumonia, and gross airleak syndromes (pneumothorax, pneumoperitoneum, pneumomediastinum, etc.). Conventional and HFOV ventilatory, gasometric and hemodynamic parameters of patients included in the protocol during a 5-month period were registered, and the first 24 hours were analyzed.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Six patients aged between 3 days and 8 years, weighing between 4 and 80 kg met the inclusion criteria. In all patients HVOF was indicated due to severe refractory ARDS. The pre-HFOV mean OI was 45.9. After 1 hour of HFOV mean OI decreased to 23.9 and continued to improve during the first 24 hours. In all patients, normal arterial PO2 and PCO2 were obtained and FiO2 could be set below 0.6 within the first 3 hours of HFOV. No complications associated with HFOV were detected. Outcome was satisfactory in two patients while four patients died secondary to multiorgan failure.</p> <span class="elsevierStyleSectionTitle">conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HFOV is a safe and effective ventilatory modality in critically ill pediatric patients in whom conventional ventilation is not effective. To obtain better results, HFOV should be started early. Every child with refractory respiratory failure should be referred early to centers where HFOV can be offered.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:46 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-conventional respiratory support modalities applicable in the older child. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 16 | 21 |
| 2024 Octubre | 50 | 93 | 143 |
| 2024 Septiembre | 56 | 46 | 102 |
| 2024 Agosto | 65 | 109 | 174 |
| 2024 Julio | 55 | 94 | 149 |
| 2024 Junio | 66 | 80 | 146 |
| 2024 Mayo | 59 | 71 | 130 |
| 2024 Abril | 52 | 57 | 109 |
| 2024 Marzo | 53 | 97 | 150 |
| 2024 Febrero | 43 | 93 | 136 |
| 2024 Enero | 41 | 76 | 117 |
| 2023 Diciembre | 34 | 60 | 94 |
| 2023 Noviembre | 47 | 80 | 127 |
| 2023 Octubre | 42 | 58 | 100 |
| 2023 Septiembre | 30 | 56 | 86 |
| 2023 Agosto | 46 | 54 | 100 |
| 2023 Julio | 46 | 55 | 101 |
| 2023 Junio | 40 | 60 | 100 |
| 2023 Mayo | 59 | 55 | 114 |
| 2023 Abril | 50 | 38 | 88 |
| 2023 Marzo | 33 | 60 | 93 |
| 2023 Febrero | 22 | 38 | 60 |
| 2023 Enero | 23 | 76 | 99 |
| 2022 Diciembre | 33 | 63 | 96 |
| 2022 Noviembre | 54 | 65 | 119 |
| 2022 Octubre | 28 | 80 | 108 |
| 2022 Septiembre | 19 | 58 | 77 |
| 2022 Agosto | 44 | 71 | 115 |
| 2022 Julio | 27 | 65 | 92 |
| 2022 Junio | 21 | 56 | 77 |
| 2022 Mayo | 26 | 57 | 83 |
| 2022 Abril | 40 | 60 | 100 |
| 2022 Marzo | 41 | 93 | 134 |
| 2022 Febrero | 21 | 60 | 81 |
| 2022 Enero | 25 | 83 | 108 |
| 2021 Diciembre | 25 | 75 | 100 |
| 2021 Noviembre | 24 | 70 | 94 |
| 2021 Octubre | 32 | 88 | 120 |
| 2021 Septiembre | 27 | 74 | 101 |
| 2021 Agosto | 22 | 42 | 64 |
| 2021 Julio | 57 | 59 | 116 |
| 2021 Junio | 36 | 89 | 125 |
| 2021 Mayo | 22 | 139 | 161 |
| 2021 Abril | 66 | 175 | 241 |
| 2021 Marzo | 75 | 52 | 127 |
| 2021 Febrero | 84 | 54 | 138 |
| 2021 Enero | 41 | 60 | 101 |
| 2020 Diciembre | 53 | 40 | 93 |
| 2020 Noviembre | 31 | 29 | 60 |
| 2020 Octubre | 31 | 36 | 67 |
| 2020 Septiembre | 24 | 21 | 45 |
| 2020 Agosto | 25 | 39 | 64 |
| 2020 Julio | 46 | 39 | 85 |
| 2020 Junio | 41 | 31 | 72 |
| 2020 Mayo | 32 | 60 | 92 |
| 2020 Abril | 31 | 19 | 50 |
| 2020 Marzo | 33 | 25 | 58 |
| 2020 Febrero | 23 | 24 | 47 |
| 2020 Enero | 43 | 35 | 78 |
| 2019 Diciembre | 39 | 35 | 74 |
| 2019 Noviembre | 29 | 26 | 55 |
| 2019 Octubre | 16 | 18 | 34 |
| 2019 Septiembre | 21 | 50 | 71 |
| 2019 Agosto | 32 | 34 | 66 |
| 2019 Julio | 24 | 32 | 56 |
| 2019 Junio | 26 | 42 | 68 |
| 2019 Mayo | 20 | 94 | 114 |
| 2019 Abril | 22 | 111 | 133 |
| 2019 Marzo | 12 | 38 | 50 |
| 2019 Febrero | 14 | 26 | 40 |
| 2019 Enero | 22 | 22 | 44 |
| 2018 Diciembre | 13 | 22 | 35 |
| 2018 Noviembre | 25 | 23 | 48 |
| 2018 Octubre | 28 | 15 | 43 |
| 2018 Septiembre | 17 | 7 | 24 |
| 2018 Julio | 1 | 0 | 1 |
| 2018 Junio | 1 | 0 | 1 |
| 2018 Mayo | 1 | 0 | 1 |
| 2018 Abril | 17 | 0 | 17 |
| 2018 Marzo | 9 | 0 | 9 |
| 2018 Febrero | 11 | 1 | 12 |
| 2018 Enero | 9 | 0 | 9 |
| 2017 Diciembre | 9 | 0 | 9 |
| 2017 Noviembre | 14 | 0 | 14 |
| 2017 Octubre | 11 | 2 | 13 |
| 2017 Septiembre | 11 | 1 | 12 |
| 2017 Agosto | 16 | 1 | 17 |
| 2017 Julio | 17 | 2 | 19 |
| 2017 Junio | 27 | 38 | 65 |
| 2017 Mayo | 21 | 37 | 58 |
| 2017 Abril | 16 | 27 | 43 |
| 2017 Marzo | 24 | 56 | 80 |
| 2017 Febrero | 14 | 64 | 78 |
| 2017 Enero | 20 | 22 | 42 |
| 2016 Diciembre | 34 | 40 | 74 |
| 2016 Noviembre | 66 | 43 | 109 |
| 2016 Octubre | 71 | 43 | 114 |
| 2016 Septiembre | 49 | 58 | 107 |
| 2016 Agosto | 54 | 26 | 80 |
| 2016 Julio | 32 | 26 | 58 |
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