High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study

Peter Fort, Christopher Farmer, Jan Westerman, Jay Johannigman, William Beninati, Steven Dolan, Stephen Derdak

Research output: Contribution to journalArticle

273 Citations (Scopus)

Abstract

Objective: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to recruit and maintain optimal lung volume in patients with severe adult respiratory distress syndrome (ARDS). Setting: Surgical and medical intensive care units in a tertiary care, military teaching hospital. Design: A prospective, clinical study. Patients: Seventeen patients, 17 yrs to 83 yrs of age, with severe ARDS (Lung Injury Score of 3.81 ± 0.23) failing inverse ratio mechanical conventional ventilation (PaO2/FiO2 ratio of 68.6 ± 21.6, peak inspiratory pressure of 54.3 ± 12.7 cm H2O, positive end-expiratory pressure of 18.2 ± 6.9 cm H2O). Interventions: High-frequency oscillatory ventilation was instituted after varying periods of conventional ventilation (5.12 ± 4.3 days). We employed a lung volume recruitment strategy that consisted of incremental increases in mean airway pressure to achieve a PaO2 of ≤60 torr (≤8.0 kPa), with an FiO2 of ≤0.6. Measurements and Main Results: High- frequency oscillator ventilator settings (FiO2, mean airway pressure, pressure amplitude of oscillation [ΔP] frequency) and hemodynamic parameters (cardiac output, oxygen delivery [ḊO2]), mean systemic and pulmonary arterial pressures, end the oxygenation index (oxygenation index = [FiO2 x mean airway pressure x 100]/PaO2) were monitored during the transition to high-frequency oscillatory ventilation and throughout the course of the high- frequency protocol. Thirteen patients demonstrated improved gas exchange and an overall improvement in PaO2/FiO2 ratio (p < .02). Reductions in the oxygenation index (p < .01) and FiO2 (p < .02) at 12, 24, and 48 hrs after starting high-frequency oscillatory ventilation were observed. No significant compromise in cardiac output or ḊO2 was observed, despite a significant increase in mean airway pressure (31.2 ± 10.3 to 34.0 ± 6.7 cm H2O, p < .05) on high-frequency oscillatory ventilation. The overall survival rate at 30 days was 47%. A greater number of pretreatment days on conventional ventilation (p < .009) and an entry oxygenation index of >47 (sensitivity 100%, specificity 100%) were associated with mortality. Conclusions: High- frequency oscillatory ventilation is both safe and effective in adult patients with severe ARDS failing conventional ventilation. A lung volume recruitment strategy during high-frequency oscillatory ventilation produced improved gas exchange without a compromise in ḊO2. These results are encouraging and support the need for a prospective, randomized trial of algorithm-controlled conventional ventilation vs. high-frequency oscillatory ventilation for adults with severe ARDS.

Original languageEnglish (US)
Pages (from-to)937-947
Number of pages11
JournalCritical Care Medicine
Volume25
Issue number6
DOIs
StatePublished - Jun 1997
Externally publishedYes

Fingerprint

High-Frequency Ventilation
Adult Respiratory Distress Syndrome
Pressure
Ventilation
Lung
Gases
Military Hospitals
Positive-Pressure Respiration
Lung Injury
Tertiary Healthcare
Mechanical Ventilators
Critical Care
Artificial Respiration
Teaching Hospitals
Cardiac Output
Intensive Care Units
Arterial Pressure
Randomized Controlled Trials
Hemodynamics
Prospective Studies

Keywords

  • Adult respiratory distress syndrome
  • High- frequency oscillation
  • High-frequency ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Fort, P., Farmer, C., Westerman, J., Johannigman, J., Beninati, W., Dolan, S., & Derdak, S. (1997). High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study. Critical Care Medicine, 25(6), 937-947. https://doi.org/10.1097/00003246-199706000-00008

High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study. / Fort, Peter; Farmer, Christopher; Westerman, Jan; Johannigman, Jay; Beninati, William; Dolan, Steven; Derdak, Stephen.

In: Critical Care Medicine, Vol. 25, No. 6, 06.1997, p. 937-947.

Research output: Contribution to journalArticle

Fort, P, Farmer, C, Westerman, J, Johannigman, J, Beninati, W, Dolan, S & Derdak, S 1997, 'High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study', Critical Care Medicine, vol. 25, no. 6, pp. 937-947. https://doi.org/10.1097/00003246-199706000-00008
Fort, Peter ; Farmer, Christopher ; Westerman, Jan ; Johannigman, Jay ; Beninati, William ; Dolan, Steven ; Derdak, Stephen. / High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study. In: Critical Care Medicine. 1997 ; Vol. 25, No. 6. pp. 937-947.
@article{23c4bd95fd394717bf82cd4f12ae14da,
title = "High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study",
abstract = "Objective: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to recruit and maintain optimal lung volume in patients with severe adult respiratory distress syndrome (ARDS). Setting: Surgical and medical intensive care units in a tertiary care, military teaching hospital. Design: A prospective, clinical study. Patients: Seventeen patients, 17 yrs to 83 yrs of age, with severe ARDS (Lung Injury Score of 3.81 ± 0.23) failing inverse ratio mechanical conventional ventilation (PaO2/FiO2 ratio of 68.6 ± 21.6, peak inspiratory pressure of 54.3 ± 12.7 cm H2O, positive end-expiratory pressure of 18.2 ± 6.9 cm H2O). Interventions: High-frequency oscillatory ventilation was instituted after varying periods of conventional ventilation (5.12 ± 4.3 days). We employed a lung volume recruitment strategy that consisted of incremental increases in mean airway pressure to achieve a PaO2 of ≤60 torr (≤8.0 kPa), with an FiO2 of ≤0.6. Measurements and Main Results: High- frequency oscillator ventilator settings (FiO2, mean airway pressure, pressure amplitude of oscillation [ΔP] frequency) and hemodynamic parameters (cardiac output, oxygen delivery [ḊO2]), mean systemic and pulmonary arterial pressures, end the oxygenation index (oxygenation index = [FiO2 x mean airway pressure x 100]/PaO2) were monitored during the transition to high-frequency oscillatory ventilation and throughout the course of the high- frequency protocol. Thirteen patients demonstrated improved gas exchange and an overall improvement in PaO2/FiO2 ratio (p < .02). Reductions in the oxygenation index (p < .01) and FiO2 (p < .02) at 12, 24, and 48 hrs after starting high-frequency oscillatory ventilation were observed. No significant compromise in cardiac output or ḊO2 was observed, despite a significant increase in mean airway pressure (31.2 ± 10.3 to 34.0 ± 6.7 cm H2O, p < .05) on high-frequency oscillatory ventilation. The overall survival rate at 30 days was 47{\%}. A greater number of pretreatment days on conventional ventilation (p < .009) and an entry oxygenation index of >47 (sensitivity 100{\%}, specificity 100{\%}) were associated with mortality. Conclusions: High- frequency oscillatory ventilation is both safe and effective in adult patients with severe ARDS failing conventional ventilation. A lung volume recruitment strategy during high-frequency oscillatory ventilation produced improved gas exchange without a compromise in ḊO2. These results are encouraging and support the need for a prospective, randomized trial of algorithm-controlled conventional ventilation vs. high-frequency oscillatory ventilation for adults with severe ARDS.",
keywords = "Adult respiratory distress syndrome, High- frequency oscillation, High-frequency ventilation",
author = "Peter Fort and Christopher Farmer and Jan Westerman and Jay Johannigman and William Beninati and Steven Dolan and Stephen Derdak",
year = "1997",
month = "6",
doi = "10.1097/00003246-199706000-00008",
language = "English (US)",
volume = "25",
pages = "937--947",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study

AU - Fort, Peter

AU - Farmer, Christopher

AU - Westerman, Jan

AU - Johannigman, Jay

AU - Beninati, William

AU - Dolan, Steven

AU - Derdak, Stephen

PY - 1997/6

Y1 - 1997/6

N2 - Objective: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to recruit and maintain optimal lung volume in patients with severe adult respiratory distress syndrome (ARDS). Setting: Surgical and medical intensive care units in a tertiary care, military teaching hospital. Design: A prospective, clinical study. Patients: Seventeen patients, 17 yrs to 83 yrs of age, with severe ARDS (Lung Injury Score of 3.81 ± 0.23) failing inverse ratio mechanical conventional ventilation (PaO2/FiO2 ratio of 68.6 ± 21.6, peak inspiratory pressure of 54.3 ± 12.7 cm H2O, positive end-expiratory pressure of 18.2 ± 6.9 cm H2O). Interventions: High-frequency oscillatory ventilation was instituted after varying periods of conventional ventilation (5.12 ± 4.3 days). We employed a lung volume recruitment strategy that consisted of incremental increases in mean airway pressure to achieve a PaO2 of ≤60 torr (≤8.0 kPa), with an FiO2 of ≤0.6. Measurements and Main Results: High- frequency oscillator ventilator settings (FiO2, mean airway pressure, pressure amplitude of oscillation [ΔP] frequency) and hemodynamic parameters (cardiac output, oxygen delivery [ḊO2]), mean systemic and pulmonary arterial pressures, end the oxygenation index (oxygenation index = [FiO2 x mean airway pressure x 100]/PaO2) were monitored during the transition to high-frequency oscillatory ventilation and throughout the course of the high- frequency protocol. Thirteen patients demonstrated improved gas exchange and an overall improvement in PaO2/FiO2 ratio (p < .02). Reductions in the oxygenation index (p < .01) and FiO2 (p < .02) at 12, 24, and 48 hrs after starting high-frequency oscillatory ventilation were observed. No significant compromise in cardiac output or ḊO2 was observed, despite a significant increase in mean airway pressure (31.2 ± 10.3 to 34.0 ± 6.7 cm H2O, p < .05) on high-frequency oscillatory ventilation. The overall survival rate at 30 days was 47%. A greater number of pretreatment days on conventional ventilation (p < .009) and an entry oxygenation index of >47 (sensitivity 100%, specificity 100%) were associated with mortality. Conclusions: High- frequency oscillatory ventilation is both safe and effective in adult patients with severe ARDS failing conventional ventilation. A lung volume recruitment strategy during high-frequency oscillatory ventilation produced improved gas exchange without a compromise in ḊO2. These results are encouraging and support the need for a prospective, randomized trial of algorithm-controlled conventional ventilation vs. high-frequency oscillatory ventilation for adults with severe ARDS.

AB - Objective: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to recruit and maintain optimal lung volume in patients with severe adult respiratory distress syndrome (ARDS). Setting: Surgical and medical intensive care units in a tertiary care, military teaching hospital. Design: A prospective, clinical study. Patients: Seventeen patients, 17 yrs to 83 yrs of age, with severe ARDS (Lung Injury Score of 3.81 ± 0.23) failing inverse ratio mechanical conventional ventilation (PaO2/FiO2 ratio of 68.6 ± 21.6, peak inspiratory pressure of 54.3 ± 12.7 cm H2O, positive end-expiratory pressure of 18.2 ± 6.9 cm H2O). Interventions: High-frequency oscillatory ventilation was instituted after varying periods of conventional ventilation (5.12 ± 4.3 days). We employed a lung volume recruitment strategy that consisted of incremental increases in mean airway pressure to achieve a PaO2 of ≤60 torr (≤8.0 kPa), with an FiO2 of ≤0.6. Measurements and Main Results: High- frequency oscillator ventilator settings (FiO2, mean airway pressure, pressure amplitude of oscillation [ΔP] frequency) and hemodynamic parameters (cardiac output, oxygen delivery [ḊO2]), mean systemic and pulmonary arterial pressures, end the oxygenation index (oxygenation index = [FiO2 x mean airway pressure x 100]/PaO2) were monitored during the transition to high-frequency oscillatory ventilation and throughout the course of the high- frequency protocol. Thirteen patients demonstrated improved gas exchange and an overall improvement in PaO2/FiO2 ratio (p < .02). Reductions in the oxygenation index (p < .01) and FiO2 (p < .02) at 12, 24, and 48 hrs after starting high-frequency oscillatory ventilation were observed. No significant compromise in cardiac output or ḊO2 was observed, despite a significant increase in mean airway pressure (31.2 ± 10.3 to 34.0 ± 6.7 cm H2O, p < .05) on high-frequency oscillatory ventilation. The overall survival rate at 30 days was 47%. A greater number of pretreatment days on conventional ventilation (p < .009) and an entry oxygenation index of >47 (sensitivity 100%, specificity 100%) were associated with mortality. Conclusions: High- frequency oscillatory ventilation is both safe and effective in adult patients with severe ARDS failing conventional ventilation. A lung volume recruitment strategy during high-frequency oscillatory ventilation produced improved gas exchange without a compromise in ḊO2. These results are encouraging and support the need for a prospective, randomized trial of algorithm-controlled conventional ventilation vs. high-frequency oscillatory ventilation for adults with severe ARDS.

KW - Adult respiratory distress syndrome

KW - High- frequency oscillation

KW - High-frequency ventilation

UR - http://www.scopus.com/inward/record.url?scp=0030967622&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030967622&partnerID=8YFLogxK

U2 - 10.1097/00003246-199706000-00008

DO - 10.1097/00003246-199706000-00008

M3 - Article

C2 - 9201044

AN - SCOPUS:0030967622

VL - 25

SP - 937

EP - 947

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 6

ER -