Skin breakdown in children and high-frequency oscillatory ventilation

Objective: To investigate the relationship of high-frequency oscillatory ve ntilation (HFOV) to skin breakdown on the scalp and ears in mechanically ve ntilated children. Study Design: Retrospective cohort study of 32 patients supported with HFOV paired with 32 patients supported with conventional mechanical ventilation (CV) in a pediatric intensive care unit (PICU). Results: By univariate analysis, more HFOV patients had skin breakdown than did the CV patients (53% vs 12.5%, p = .001); HFOV patients also had great er severity of illness (Pediatric Risk of Mortality scores), higher mortali ty, and longer durations of neuromuscular blockade, low systolic blood pres sure, and time exposed to risk. Life table analysis demonstrated no differe nce in the rate of skin breakdown between HFOV and CV patients. Multifactor ial analysis showed that only PICU time at risk was a risk factor for skin breakdown. Conclusions: HFOV was not an independent risk factor for the development of skin breakdown. PICU time at risk was the sole risk factor for the develop ment of skin breakdown in all mechanically ventilated patients in the PICU. (C) 1998 by the American Congress of Rehabilitation Medicine and the Ameri can Academy of Physical Medicine and Rehabilitation.