Verhoeven, J.M.A. (2014) Voorspellers voor een gunstig effect van HFOV bij kinderen met acuut hypoxaemisch respiratoir falen. thesis, Medicine.
![[img]](https://umcg.studenttheses.ub.rug.nl/style/images/fileicons/text.png) |
Text
VerhoevenJ.pdf Restricted to Registered users only Download (1MB) |
Abstract
Introduction: The purpose of ventilation is partially or completely taking over breathing when it fails. Although ventilation ensures a significant reduction in mortality, it also causes an increase in lung injury and multi-organ failure. The use of high tidal volumes is one of the causative factors. For this reason nowadays low tidal volumes are used in ventilation (called lung protective breathing). However, this is not always enough. Therefore, high-frequency oscillatory ventilation (HFOV) can be used. HFOV is an alternative way of lung protective breathing in which tidal volumes are administered that are smaller than the dead space. The effect of HFOV is still seriously doubted. This is due to the many conflicting results from different studies. The Beatrix Children's Hospital Groningen, as one of the few in the world, uses a physiological HFOV strategy. This physiological HFOV strategy is used as a first form of treatment, and an open lung strategy is used by means of recruitment. This study was designed to examine the safety of this strategy and to evaluate whether it can be predicted which patients respond favorably to HFOV. Method: This study was designed as a retrospective observational cohort study. The patients were aged between 0 and 18 years, were admitted to the hospital between 2011 and 2013, were ventilated with HFOV in that period and diagnosed with acute hypoxemic respiratory failure (AHRF). Patients with asthma were excluded. Survey data were collected from statuses. The survey data were divided into demographic data, clinical data and clinical course of the admission. Patients were divided into three groups: group one included patients with a decrease in the OI of more than 20% between the first hour after the start of HFOV and the sixth hour of the start of HFOV. Group two contains the patients with a decrease in the OI of less than 20% between the first hour after the start of HFOV and the sixth hour of the start of HFOV and group three contains the patients with an increase in the OI between the first hour after start of HFOV and the sixth hour of the start of HFOV. For statistical analyzes, the one-way ANOVA, Kruskal-Wallis and chi-square test were used. Charts were obtained by using Prism 6. Results: 45 Patients were included with a median age of 4.5 months. These 45 patients were divided into three groups. First, we looked at the safety and effectiveness. The PaCO2 decreased in all three groups when switched to HFOV and Hf reduced in all three groups over time. Also, the pMODS score and the PELOD score show a decrease in group one. Subsequently the predictors of a favorable response to HFOV were evaluated. A clear difference could be seen in the duration of conventional ventilation prior to HFOV (group 1: 17h, group 2: 36h, group 3: 14h) and that the mortality was highest in group two (33%). Furthermore, the CDP hardly changed overtime and the P/F decreased in all three groups when switched to HFOV. Conclusion: This study showed that the physiological HFOV strategy does not lead to serious complications and could be at least as effective and safe as conventional ventilation. Furthermore, this study showed that no favorable predictors for the HFOV outcome can be found. It can be suggested that an early start of HFOV creates favorable outcomes. It is desirable to continue this pilot study and expand to a study with a larger population to obtain significance.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kneyber, Dr. M.C.J. MD PhD |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:02 |
| Last Modified: | 25 Jun 2020 11:02 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2200 |
Actions (login required)
 |
View Item |