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High-frequency oscillatory ventilation in acute respiratory distress syndrome in adult patients
Critical Care volume 10, Article number: P21 (2006)
To evaluate the efficacy of high-frequency oscillatory ventilation (HFOV) in acute respiratory distress syndrome (ARDS) in adult patients.
A 30-bed medical and surgical ICU of a tertiary care hospital.
A prospective clinical study over a period of 12 months.
ARDS patients receiving mechanical ventilation as per the ARDSnet protocol and requiring positive end expiratory pressure (PEEP) ≥ 12 cmH2O and FiO2 ≥ 0.7 to maintain oxygen saturation ≥ 88% were considered for HFOV. Initial settings of HFOV were selected based upon the mean airway pressure (MAP), PO2/FiO2 ratio, PCO2 and oxygenation index (OI) (OI = MAP × FiO2 × 100 / PO2). Predetermined protocols for HFOV adjustments and weaning from HFOV were implemented. Continuous hemodynamic, plethysmographic monitoring was performed. Arterial blood gas parameters were documented at 1, 6 and 24 hours after initiation of HFOV.
A total of 18 patients were ventilated with HFOV for 80.82 ± 58.70 hours. Baseline characteristics before initiation of HFOV were: APACHE II score 21.11 ± 4.65, hours of conventional ventilation 61.83 ± 52.77, PEEP of 14.16 ± 3.7 cmH2O, plateau pressure (Pplat) of 29.44 ± 4.93 cm, FiO2 of 0.89 ± 0.11 and average ≥ 3 organs failure. There was an improvement in oxygenation status at 6 and 24 hours. The ratio PO2/FiO2 increased from a baseline of 97.47 ± 27.92 to 181.26 ± 110.37 and 256.41 ± 130.85 at 6 and 24 hours, respectively. The OI reduced from a baseline of 26 ± 10.98 to 23.59 ± 16.98 and 15.95 ± 12.38 at 6 and 24 hours, respectively. Out of 18 patients 13 were 'Responders' – i.e. showed progressive and sustained improvement in oxygenation and were successfully weaned to 'T' piece oxygen (≥ 12 hours without any ventilatory assistance). The remaining five were 'Non Responders' and did not show sustained improvement in oxygenation and died of resistant hypoxia.
The Responder (n = 13) and Non Responder (n = 5) groups were similar in Pre HFOV baseline characteristics such as age, APACHE II score, number of organs failed, Pplat, ratio and OI. The PO2/FiO2 ratios at 6 hours were PO2/FiO2 208.81 ± 110.96 vs 109.61 ± 77.41 (P = 0.04) in Responders and Non Responders, respectively. PO2/FiO2 ratios at 24 hours were 290.78 ± 117.43 vs 167.05 ± 132.58 (P = 0.03) in Responders and Non Responders, respectively. The reduction in OI in the Responder group at 6 and 24 hours was significant as compared with Non Responders: 17.27 ± 8.37 vs 40.01 ± 23.42 at 6 hours (P = 0.003) and 11.17 ± 4.28 vs 28.36 ± 18.16 at 24 hours (P = 0.002). One patient developed pneumothorax and one patient had endotracheal tube displacement while on HFOV.
HFOV is effective in adult patients with severe ARDS failing conventional ventilation. Progressive and sustained improve-ment in the PO2/FiO2 ratio and the reduction in the OI at 6 and 24 hours are strongly associated with successful response to HFOV.
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Jog, S., Bhadange, N. & Rajhans, P. High-frequency oscillatory ventilation in acute respiratory distress syndrome in adult patients. Crit Care 10, P21 (2006). https://doi.org/10.1186/cc4368
- Acute Respiratory Distress Syndrome
- Oxygenation Index
- Sustained Improvement
- Acute Respiratory Distress Syndrome Patient