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 journalReview article

276 Scopus citations

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 1 1997

Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study'. Together they form a unique fingerprint.

  • 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