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High-frequency oscillatory ventilation and adult patients with acute respiratory distress syndrome: our impressions and experience

Introduction

An analysis of clinical experience of patients treated with high-frequency oscillatory ventilation (HFOV) was performed. This alternative technique of mechanical ventilation is used as 'rescue' therapy for patients with severe acute respiratory distress syndrome (ARDS) when it is not possible to provide adequate oxygenation and ventilation by conventional methods.

Methods

A prospective review of all patients treated with HFOV (SensorMedics 3100B) in the ICU during 2004–2006. The data (patient demographics, aetiology of ARDS, gas exchange, ventilator settings before and after initiation of HFOV, duration of HFOV, complications, outcome at 30 days, etc.) were obtained and statistical analysis was performed (mean ± SD, %, t test). For all analyses P < 0.05 was considered significant.

Results

Values given as mean ± SD. Thirty-one patients (13 women and 18 men, age 42.8 ± 16.1 years; APACHE II score, 22.1 ± 4.9) with severe ARDS (PaO2/FiO2, 72.0 ± 14.7; oxygena tion index (OI), 44.0 ± 16.5) were connected to HFOV (38 trials) after previous conventional ventilation (CV) for a duration of 6.8 ± 4.1 days with ventilator settings (plateau, 39.3 ± 5.1 cmH2O; PEEP, 14.5 ± 3.6 cmH2O; mPaw, 26.5 ± 6.3 cmH2O). Patients were treated with HFOV for 4.7 ± 2.1 days. The 30-day mortality rate was 70.9%. Of the patients 51.6% were treated with steroids, and 22.6% of patients underwent prone positioning. Survivors/nonsurvivors: 6/9 women, 3/13 men; age 27.4 ± 4.9/49.0 ± 16 years; duration of CV 4.4 ± 3.1/7.8 ± 4.0 days; ventilator settings – plateau 41.2 ± 4.3/38.5 ± 5.2 cmH2O, PEEP 16 ± 1.9/13.9 ± 4.0 cmH2O, mPaw 26.6 ± 3.4/26.4 ± 7.1 cmH2O; duration of HFOV 6.4 ± 1.4/4.0 ± 1.9 days.

Conclusion

We found significant improvement in PaO2/FiO2, the OI and reduction in paCO2 within 12 hours of transition to HFOV. The age of patients and days on CV were significantly higher in nonsurvivors (49 years; 7.8 days) than in survivors (27 years; 4.4 days). Early treatment with HFOV can help to bridge the most critical period of respiratory failure and improve the mortality rate. Timing of HFOV initiation is the most important factor; that is, early intervention may improve outcome.

References

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Pokorny, L., Bartova, R., Rolecek, P. et al. High-frequency oscillatory ventilation and adult patients with acute respiratory distress syndrome: our impressions and experience. Crit Care 12, P285 (2008). https://doi.org/10.1186/cc6506

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Keywords

  • Steroid
  • Mechanical Ventilation
  • Respiratory Failure
  • Patient Demographic
  • Prone Position