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Critical Care

Open Access

High-frequency oscillatory ventilation after cardiac surgery: a treatment for all ages

  • Ravi S Tripathi1Email author,
  • Erica J Stein1,
  • Juan A Crestanello2 and
  • Thomas J Papadimos1
Critical Care201216:405

https://doi.org/10.1186/cc10605

Published: 23 January 2012

In a recent issue of Critical Care, Bojan and colleagues [1] reported their experience with early initiation of high-frequency oscillatory ventilation (HFOV) in pediatric cardiac surgery that demonstrated shorter mechanical ventilation times and intensive care stays. Acute lung injury is common in adult patients undergoing surgery, yet there is scant reporting of the intraoperative utility of HFOV [2].

We initiated HFOV in a 49-year-old morbidly obese (body mass index of 69 kg/m2) man who had aortic stenosis, pulmonary hypertension, and decompensated congestive heart failure and who was undergoing aortic valve replacement. Separation from cardiopulmonary bypass (CPB) with inverse-ratio pressure-control ventilation - fraction of inspired oxygen (FiO2) of 1.0 and positive end-expiratory pressure (PEEP) of 18 cm H2O - failed because of hypoxia, defined as an arterial partial pressure of oxygen (PaO2) of 64 mm Hg. HFOV was initiated (mean pressure airway of 33 cm H2O and FiO2 of 1.0), yielding a PaO2 of 74 mm Hg and allowing CPB separation. The patient was transitioned to conventional ventilation on postoperative day 3 and was extubated on postoperative day 5.

This adult patient benefited from HFOV, as did the pediatric population of Bojan and colleagues. Continuous positive intrathoracic pressure is a concern as it may impede venous return and thereby limit cardiac output (CO) [3]. However, the transition from ventilation with PEEP to HFOV usually results in significant changes in oxygenation/ventilation but not in CO [4]. In patients with pulmonary hypertension, HFOV has been demonstrated to increase CO and decrease pulmonary vascular resistance [5]. For our patient, HFOV allowed improved oxygenation without affecting hemodynamics.

HFOV may be a safe and effective therapy to improve oxygenation/ventilation in patients undergoing cardiac surgery and possibly is underused because of unfounded hemodynamic concerns. HFOV needs exploration as a rescue tool after CPB for patients with hypoxia.

Abbreviations

CO: 

cardiac output

CPB: 

cardiopulmonary bypass

FiO2

fraction of inspired oxygen

HFOV: 

high-frequency oscillatory ventilation

PaO2

arterial partial pressure of oxygen

PEEP: 

positive end-expiratory pressure.

Declarations

Authors’ Affiliations

(1)
Department of Anesthesiology, The Ohio State University Medical Center, Columbus, USA
(2)
Department of Surgery, Division of Cardiac Surgery, The Ohio State University Medical Center, Columbus, USA

References

  1. Bojan M, Gioanni S, Mauriat P, Pouard P: High-frequency oscillatory ventilation and short-term outcome in neonates and infants undergoing cardiac surgery: a propensity score analysis. Crit Care 2011, 15: R259. 10.1186/cc10521PubMed CentralView ArticlePubMedGoogle Scholar
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  4. Nakagawa R, Koizumi T, Ono K, Tsushima K, Yoshikawa S, Kubo K, Otagiri T: Cardiovascular responses to high-frequency oscillatory ventilation during acute lung injury in sheep. J Anesth 2007, 21: 340-347. 10.1007/s00540-007-0508-zView ArticlePubMedGoogle Scholar
  5. Meliones JN, Bove EL, Dekeon MK, Custer JR, Moler FW, Callow LR, Wilton NC, Rosen DB: High-frequency jet ventilation improves cardiac function after the Fontan procedure. Circulation 1991,84(5 suppl):III364-368.PubMedGoogle Scholar

Copyright

© BioMed Central Ltd 2012

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