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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
Critical Care volume 17, Article number: P121 (2013)
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.
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
Zeravik J, et al.: Acta Anaesthesiol Scand. 1989, 33(Suppl 90):149-152.
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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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
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DOI: https://doi.org/10.1186/cc12059
Keywords
- Tracheal Tube
- Oscillatory Pressure
- Pressure Amplitude
- Hemodynamic Measurement
- Lung Mechanic