High frequency percussive ventilation in pediatric patients with inhalation injury

The objective of this study was to present data that showed high frequency percussive ventilation (HFPV) was superior to traditional mechanical ventil ation for the treatment of children with inhalation injuries. Inhalation in juries continue to be the number one cause of death of patients with therma l injuries in the United States. Therapy for this condition has consisted o f conservative pulmonary toilet and mechanical ventilation. Despite improve ments in the management of burn injury, patients with inhalation injury dev elop pneumonia and pneumothorax, leading to adult respiratory distress synd rome. Unfortunately, inhalation injury that is complicated by pneumonia has been shown to increase mortality by 60% in these patients. Cioffi has show n that prophylactic use of HFPV in adult patients with inhalation injury ha s been a successful method of reducing the incidence of pneumonia and morta lity. The effects of HFPV on the incidence of pneumonia, peak inspiratory p ressures, and arterial partial pressure of oxygen/fraction of inspired conc entration of oxygen (P/F) ratios were retrospectively studied in 13 childre n with inhalation injuries and compared with historic controls treated with conventional mechanical ventilation. All patients were treated with our st andard inhalation injury protocol and extubated a hen they met standard ext ubation criteria. Patients ranged in age from 6 to 9 years, and most had bu rns covering greater than 50% of their total body surface areas. No deaths occurred in either group, but the patients who were treated with HFPV had n o cases of pneumonia (P < .05), better P/P ratios (P < .05), lower peak ins piratory pressures, and less work of breathing (P < .05) as compared with o ur control group. On the basis of our clinical experience and data, the use of HFPV seems to be an effective treatment for the reduction of pulmonary morbidity in pediatric patients with inhalation injuries.