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Improvement in oxygenation with high-frequency oscillatory ventilation combined with tracheal gas insufflation is correlated to the extravascular lung water index

Introduction

High-frequency oscillatory ventilation combined with tracheal gas insufflation (HFO-TGI) can significantly improve oxygenation in patients with ARDS. It has been demonstrated that oxygenation in patients with ARDS has a better response to HFO when extravascular lung water is >15 ml/kg body weight (BW). Our aim is to examine whether the extravascular lung water index (ELWI) correlates with changes in PaO2/FiO2 in patients ventilated with HFO-TGI.

Methods

Data from 18 sessions of HFO-TGI in six patients were included in the analysis. HFO frequency, oscillatory pressure amplitude, and bias flow were 3.5 Hz, 85 to 95 cmH2O, and 40 l/minute, respectively; a 2.5 to 3.5 cmH2O tracheal tube cuff leak was used. HFO mean airway pressure (mPaw) exceeded preceding conventional ventilation (CV)-mPaw by 7 to 13 cmH2O. PaO2/FiO2, lung mechanics, and hemodynamics were documented during lung-protective CV (baseline) and 1 hour following the initiation of HFO-TGI ventilation. PULSION PICCOplus v7.0 was used for hemodynamic measurements including the ELWI.

Results

Oxygenation (PaO2/FiO2) improved significantly with HFO-TGI compared with CMV (125.5 ± 54.7 vs. 195.6 ± 108.7, P < 0.001). Changes in PaO2/FiO2 were positively correlated with ELWI at baseline (Spearman's ρ = 0.56, P = 0.016). See Figure 1. There were no significant changes in patients' fluid balance and hemodynamics including the ELWI.

Figure 1
figure1

Scatter plot and fit line of ELWI versus dPaO 2 /FiO 2 .

Conclusion

Estimation of the ELWI can help to predict the oxygenation response of ARDS patients considered for HFO-TGI ventilation. The possibility that HFO-TGI exerts an effect on pulmonary oedema needs further investigation.

References

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Acknowledgements

This research has been cofinanced by the European Union and Greek national funds through the operating programme 'Education and Lifelong Learning' - Research Funding Programme Heracleitus II.

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Correspondence to CS Vrettou.

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Vrettou, C., Malachias, S., Zakynthinos, S. et al. Improvement in oxygenation with high-frequency oscillatory ventilation combined with tracheal gas insufflation is correlated to the extravascular lung water index. Crit Care 17, P121 (2013). https://doi.org/10.1186/cc12059

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Keywords

  • Tracheal Tube
  • Oscillatory Pressure
  • Pressure Amplitude
  • Hemodynamic Measurement
  • Lung Mechanic