• J R Tang, K I Yau, and H H Shih.
• Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
• Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 Mar 1; 38 (2): 137-44.

AbstractTwo infants and two children suffered from severe hypoxemia, presenting as a ratio of arterial to alveolar PaO2 < 0.1, persisting for more than 3 hours in spite of high settings on conventional mechanical ventilator. Adult respiratory distress syndrome was diagnosed with the support of bilateral diffuse haziness on chest radiographs. High-frequency oscillatory ventilation with high-lung-volume strategy resulted in prompt decrease in oxygenation index and increase in ratio of arterial to alveolar P O2 in three (75%) of the 4 patients within 6 hours. After a mean duration of 96 hours, high-frequency oscillatory ventilation could be weaned off and conventional ventilation could be resumed at lower mean airway pressure in 3 patients. They continued to improve and finally recovered. The other one showed initially steady improvement on high-frequency oscillatory ventilation for 20 hours, but ultimately died of unresolved cytomegalovirus pneumonitis and intractable pulmonary hemorrhage. There were 2 episodes of pneumothorax developing during high-frequency oscillatory ventilation. After decreasing mean airway pressure and amplitude, the airleak resolved with chest tube insertion. We conclude that high-frequency oscillatory ventilation with high-lung-volume strategy may be an effective rescue therapy to relieve profound hypoxemia in infants and children with adult respiratory distress syndrome.

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