High-frequency oscillatory ventilation in severe lung haemorrhage: A case study of three centres

Summary 

Aim

To describe the safety and efficacy of HFOV as a rescue therapy for lung haemorrhage.

Methods

We conducted a retrospective case study of nine children. Lung haemorrhage was defined as large amounts of blood-stained effluent not attributable to a cardiovascular malformation or trauma, with bilateral opacities on chest X-ray. HFOV was started when conventional ventilation was ineffective in controlling the haemorrhage resulting in hypoxaemia or hypercarbia. A strategy was used aiming at tamponading transudation of oedema and decreasing blood flow from ruptured vessels.

Results

Seven infants improved significantly on HFOV. Two infants died, both showing an increasing oxygenation index.

Conclusions

HFOV therapy can be life-saving in massive lung haemorrhage in children, using a strategy with high pressures to tamponade transudation of haemorrhagic oedema, and to decrease blood flow from ruptured arterioles by reducing blood flow and increasing intrathoracic pressure. Similar to previous trials, an increasing oxygenation index was a sign of imminent death.

Keywords: Paediatrics, Lung haemorrhage, High-frequency oscillatory ventilation, Respiratory failure

Abbreviations: HFOV, high-frequency oscillatory ventilation, CMV, conventional mechanical ventilation, HPO, haemorrhagic pulmonary oedema, ECMO, extracorporeal membrane oxygenation, AVSD, atrioventricular septum defect, BiPAP, biphasic positive airway pressure, Paw, mean airway pressure, CDP, continuous distending pressure, OI, oxygenation index, MVI, modified ventilatory index, CMV-pneumonia, cytomegalovirus pneumonia, DIC, disseminated intravascular coagulation, HFV, high-frequency ventilatory