High frequency oscillatory ventilation is a new mode of ventilatory support of acute respiratory failure in the pediatric population. Delineating the nursing care required of this fragile group of infants and children is challenging, because there is a paucity of published data and national clinical experience. The author reviews a management plan that was used to guide the care of over 40 patients, ranging in age from 1 month to 24 years, with acute respiratory failure supported on high frequency oscillatory ventilation. In total, seven patient-care problems and associated interventions are delineated.
Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. The history, mechanics, and current applications of ECMO are discussed in this article. Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed