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Research Snapshot Theater: Pulmonary, Pediatric I

Lung-Protective Ventilation Using High-Frequency Percussive Ventilation in Pediatrics

Tuesday, March 24, 2026
8:45 AM - 9:45 AM Central Time
Location: Connections Central - RST 13
Introduction: In the PICU, respiratory failure is a common indication for mechanical ventilation, which can lead to ventilator-induced lung injury. This study examines whether the use of high frequency percussive ventilation (HFPV) is associated with increased rates of lung protective ventilation (LPV).


Methods: This was a single-site, retrospective observational cohort study of patients who received HFPV at a quaternary care center from January 2015 to April 2024. The primary outcome was the rate of LPV while on HFPV. Secondary outcomes included comparison of LPV rates between patients with and without bronchiolitis. The definition of LPV was derived from the PALICC-2 guidelines and defined as meeting all of the following criteria: (1) peak inspiratory pressure (PIP) ≤ 28 cm H₂O, (2) compliance with the ARDSnet low PEEP/FiO₂ table, and (3) arterial pH ≥ 7.20. Wilcoxon rank-sum tests were used to compare continuous data and chi-square and Fisher’s exact tests were used to compare categorical data. To compare rates of LPV across timepoints, we used McNemar’s test, a non-parametric test for paired nominal data.


Results: There were a total of 111 separate uses of HFPV. A total of 76 patients (68.5%) had bronchiolitis. Prior to HFPV, 15.7% (11/70) of patients with bronchiolitis met LPV criteria compared to 12.1% (4/33) in the non-bronchiolitis group. In patients with bronchiolitis, LPV adherence increased significantly to 44.6% (29/65, p < 0.001) after 6 hours of HFPV compared to pre-HFPV and remained significantly higher after 24 hours (56.8%, 42/74, p < 0.001) and on the last day of HFPV (76.1%, 54/71, p < 0.001). In patients without bronchiolitis, LPV adherence did not increase significantly after 6 hours on HFPV (26.5%, 9/34, p = 0.34). However, LPV adherence in patients without bronchiolitis did increase significantly after 24 hours of HFPV to 38.2% (13/34, p < 0.001) and remained increased on the last day of HFPV (53.0%, 18/34, p = 0.001). A PIP above 28 was the primary driver of non-LPV at each time point.


Conclusions: The use of HFPV in pediatric patients increased rates of LPV. Patients with bronchiolitis had a statistically significant increase in the rate of LPV earlier in their course of HFPV compared to patients without bronchiolitis.