Improvement in oxygenation with high-frequency oscillatory ventilation combined with tracheal gas insufflation is correlated to the extravascular lung water index
Critical Care volume 17, Article number: P121 (2013)
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.
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.
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.
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.
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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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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 (Suppl 2), P121 (2013). https://doi.org/10.1186/cc12059
- Tracheal Tube
- Oscillatory Pressure
- Pressure Amplitude
- Hemodynamic Measurement
- Lung Mechanic