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Outcome predictors of high-frequency oscillatory ventilation in acute respiratory distress syndrome

Introduction

Outcome predictors of high-frequency oscillatory ventilation (HFOV) in severe ARDS are not well studied.

Objective

To evaluate outcome predictors of HFOV in adult patients with ARDS.

Methods

ARDS patients receiving mechanical ventilation as per the ARDSnet protocol with PO2/FiO2 <150, PEEP ≥12 cm and FiO2 ≥0.7 were considered for HFOV. The continuous distending pressure (CDP), frequency, amplitude, inspiratory time and bias flow of HFOV were optimised, guided by frequent blood gas analysis. Weaning from HFOV to pressure support ventilation was attempted once the PO2/FiO2 ratio remained ≥200 with CDP ≤18 cm FiO2 ≤0.5. Responders (R) were defined as patients who were successfully weaned to a state without any ventilatory support for >12 hours. Nonresponders (NR) could not be weaned off any ventilatory assistance.

Results

Fifteen out of the total 28 patients were R and 13 were NR. Both the groups were similar prior to HFOV in terms of APACHE II score, number of organ failures, PEEP and plateau pressures, and duration of ventilation before HFOV. The baseline PO2/FiO2 ratio and improvement in it at 6 hours and 24 hours in the R group were statistically significantly higher as compared with that in the NR group. The difference in improvement in the oxygenation index (OI) of the two groups at 6 and 24 hours was also statistically significant. The rate of improvement in the PO2/FiO2 ratio and OI in NR was slower than that in R, and this difference was statistically significant (trend test). See Figure 1.

Figure 1
figure1

VCV, volume controlled ventilation.

Conclusion

A lower PO2/FiO2 ratio and higher OI prior to HFOV and slow improvement in the PO2/FiO2 ratio and OI at 6 and 24 hours on HFOV are significant negative outcome predictors of HFOV in ARDS.

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Jog, S., Akole, P., Rajhans, P. et al. Outcome predictors of high-frequency oscillatory ventilation in acute respiratory distress syndrome. Crit Care 11, P199 (2007). https://doi.org/10.1186/cc5359

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Keywords

  • Acute Respiratory Distress Syndrome
  • Pressure Support
  • Oxygenation Index
  • Outcome Predictor
  • Pressure Support Ventilation