Severe Paroxysmal Sinus Bradycardia Associated With High-Frequency Oscillatory Ventilation

• Published in: Chest Vol. 112; no. 1; pp. 181 - 185
• Main Authors: Mellema, James D., Baden, Harris P., Martin, Lynn D., Bratton, Susan L.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.07.1997; American College of Chest Physicians
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arrhythmia, Sinus - epidemiology; Arrhythmia, Sinus - etiology; Biological and medical sciences; bradycardia; Bradycardia - epidemiology; Bradycardia - etiology; Case-Control Studies; Emergency and intensive respiratory care; Female; high-frequency oscillatory ventilation; High-Frequency Ventilation - adverse effects; Humans; Incidence; Infant; Intensive care medicine; Intensive Care Units, Pediatric; Male; Medical sciences; positive pressure ventilation; Respiration, Artificial; restrictive lung disease; Risk Factors; sinus arrhythmias; Time Factors; sinus arrhythmias; high-frequency oscillatory ventilation; restrictive lung disease; bradycardia; positive pressure ventilation; Human; Arrhythmia; Pathophysiology; Respiratory disease; Cardiovascular disease; Respiratory intensive care; Sinus bradycardia; Artificial ventilation; Oscillation method; Excitability disorder; Oxygenotherapy; Treatment; Clinical management; Heart disease; Complication; Frequency; High frequency; Pneumopathy; Child
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.112.1.181

To determine the incidence of and risk factors for unexplained paroxysmal bradycardia in children treated with high-frequency oscillatory ventilation (HFOV). A nested case-control study. A university-affiliated children's hospital. All children treated with HFOV for at least 3 days during a 2-year period and a randomly chosen comparison group of 50 children treated with only conventional mechanical ventilation (CMV) for at least 3 days during the same time period. None. Unexplained paroxysmal sinus bradycardia occurred in six children (12%) receiving HFOV, and was significantly more common than in children treated with CMV (0%). The bradycardic events occurred after the lung disease started to improve, and the mean airway pressure (mPaw) at the time of the bradycardias was significantly decreased from the child's maximal mPaw. The bradycardic events were effectively treated acutely with manual ventilation or atropine sulfate, and resolved completely after the patient was changed to a regimen of CMV. Unexplained paroxysmal bradycardia associated with HFOV in children is not uncommon. It completely resolves with conversion to CMV and may be related to overdistention of alveoli as compliance improves.