Combining high-frequency oscillatory ventilation and recruitment maneuvers in adults with early acute respiratory distress syndrome: The Treatment with Oscillation and an Open Lung Strategy (TOOLS) Trial pilot study*

Ferguson, Niall D.; Chiche, Jean‐Daniel; Kacmarek, Robert M.; Hallett, David; Mehta, Sangeeta; Findlay, George; Granton, John; Slutsky, Arthur S.; Stewart, Thomas E.

doi:10.1097/01.ccm.0000155785.23200.9e

Cited by 113 publications

(95 citation statements)

References 36 publications

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“…During the recruitment period, the 2.3-fold average Pa,O 2 /FI,O 2 rise was consistent with enhanced lung recruitment [6][7][8][9][10]20]. This enabled reduction of the initial respiratory system distending pressure by 6 cmH 2 O (stabilisation period), with maintenance of ,85% of the oxygenation benefit.…”

Section: Discussionmentioning

confidence: 83%

“…The CMV group received lung-protective CMV and RMs for days 1-4 post-randomisation (table 1); the likelihood of sustained, RM-induced oxygenation improvement decreases and the risk of RM haemodynamic complications increases with CMV time [17]. In the HFO-TGI group, RMs were used after day 4 as part of the HFO-TGI protocol; RM-related oxygenation benefits are maintained when RMs are followed by HFO, even when HFO-time exceeds 4 days [6]. During days 1-4, minimum RM frequency was four per day in both groups.…”

Section: Study Design and Randomisationmentioning

confidence: 99%

“…When combined with 40-s recruitment manoeuvres (RMs), HFO improves oxygenation versus lung-protective CMV, probably through lung recruitment [6][7][8]. The short-term addition of tracheal gas insufflation (TGI) to HFO may further improve oxygenation versus HFO without TGI and lung-protective CMV [7,8].…”

mentioning

confidence: 99%

“…1). e : in both groups, before each RM, we pre-oxygenated the patient by using an FI,O2 of 100% for o5 min to reduce the risk of RM-associated desaturation [6]; for additional details, see the online supplementary material.…”

mentioning

confidence: 99%

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Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

Mentzelopoulos¹,

Malachias²,

Ζιντζαράς³

et al. 2011

European Respiratory Journal

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In acute respiratory distress syndrome (ARDS), recruitment sessions of highfrequency oscillation (HFO) and tracheal gas insufflation (TGI) with short-lasting recruitment manoeuvres (RMs) may improve oxygenation and enable reduction of subsequent conventional mechanical ventilation (CMV) pressures. We determined the effect of adding HFO-TGI sessions to lung-protective CMV on early/severe ARDS outcome.We conducted a prospective clinical trial, subdivided into a first single-centre period and a second two-centre period. We enrolled 125 (first period, n554) patients with arterial oxygen tension (Pa,O 2 )/inspiratory oxygen fraction (FI,O 2 ) of ,150 mmHg for .12 consecutive hours at an end-expiratory pressure of o8 cmH 2 O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n561) or CMV group (receiving lung-protective CMV and RMs; n564). The primary outcome was survival to hospital discharge.Pre-enrolment ventilation duration was variable. During days 1-10 post-randomisation, Pa,O 2 / FI,O 2 , oxygenation index, plateau pressure and respiratory compliance were improved in the HFO-TGI group versus the CMV group (p,0.001 for group6time). Within days 1-60, the HFO-TGI group had more ventilator-free days versus the CMV group (median (interquartile range) 31.0 (0.0-42.0) versus 0.0 (0.0-23.0) days; p,0.001), and more days without respiratory, circulatory, renal, coagulation and liver failure (pf0.003). Survival to hospital discharge was higher in the HFO-TGI group versus the CMV group (38 (62.3%) out of 61 versus 23 (35.9%) out of 64 subjects; p50.004).Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.

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Section: Discussionmentioning

confidence: 83%

Section: Study Design and Randomisationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

Mentzelopoulos¹,

Malachias²,

Ζιντζαράς³

et al. 2011

European Respiratory Journal

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“…Some observational studies have shown improved oxygenation in patients with refractory hypoxemia. 3,4 A recent Cochrane review concluded that HFOV may be a rescue therapy for improving survival in ARDS patients. 5 Herein is a case of TRALI with persistent hypoxemia under pressure-control ventilation mode with 100% oxygen, low tidal volume, and high PEEP.…”

Section: Introductionmentioning

confidence: 99%

High-Frequency Oscillatory Ventilation for Rescue From Refractory Hypoxemia in a Patient With Transfusion-Related Acute Lung Injury

Huang

Hsieh

et al. 2012

Respir Care

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Transfusion-related acute lung injury is a serious complication of blood transfusions. Herein is a report on a 32-year-old woman who developed diffuse pulmonary infiltrates and acute respiratory compromise after blood transfusion. Non-cardiogenic pulmonary edema was diagnosed based on data calculated by the hemodynamic monitoring system, but severe hypoxemia persisted despite conventional pressure-control ventilation with 100% oxygen, low tidal volume, and high PEEP. The refractory hypoxemia was improved by high-frequency oscillatory ventilation. This experience suggests that high-frequency oscillatory ventilation may be beneficial for patients with transfusionrelated acute lung injury and severe refractory hypoxemia. Key words: high-frequency oscillatory ventilation; refractory hypoxemia; transfusion-related lung injury. [Respir Care 2012;57(5):798 -801.

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Therapies for Refractory Hypoxemia in Acute Respiratory Distress Syndrome

Pipeling¹,

Fan²

2010

JAMA

116

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Combining high-frequency oscillatory ventilation and recruitment maneuvers in adults with early acute respiratory distress syndrome: The Treatment with Oscillation and an Open Lung Strategy (TOOLS) Trial pilot study*

Cited by 113 publications

References 36 publications

Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

High-Frequency Oscillatory Ventilation for Rescue From Refractory Hypoxemia in a Patient With Transfusion-Related Acute Lung Injury

Therapies for Refractory Hypoxemia in Acute Respiratory Distress Syndrome

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