Early Short-Term Application of High-Frequency Percussive Ventilation Improves Gas Exchange in Hypoxemic Patients

Abstract

Background: Hypoxemia in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients represents a common finding in the intensive care unit (ICU) and frequently does not respond to standard ventilatory techniques. Objective: To study whether the early short-term application of high-frequency percussive ventilation (HFPV) can improve gas exchange in hypoxemic patients with ALI/ARDS or many other conditions in comparison to conventional ventilation (CV) using the same mean airway pressure (P_aw), representing the main determinant of oxygenation and hemodynamics, irrespective of the mode of ventilation. Methods: Thirty-five patients not responding to CV were studied. During the first 12 h after admission to the ICU the patients underwent CV. Thereafter HFPV was applied for 12 h with P_aw kept constant. They were then returned to CV. Gas exchange was measured at: 12 h after admission, every 4 h during the HFPV trial, 1 h after the end of HFPV, and 12 h after HFPV. Thirty-five matched patients ventilated with CV served as the control group (CTRL). Results: Pa<smlcap>o</smlcap>₂/Fi<smlcap>o</smlcap>₂ and the arterial alveolar ratio (a/A P<smlcap>o</smlcap>₂) increased during HFPV treatment and a Pa<smlcap>o</smlcap>₂/Fi<smlcap>o</smlcap>₂ steady state was reached during the last 12 h of CV, whereas both did not change in CTRL. Pa<smlcap>c</smlcap><smlcap>o</smlcap>₂ decreased during the first 4 h of HFPV, but thereafter it remained unaltered; Pa<smlcap>c</smlcap><smlcap>o</smlcap>₂ did not vary in CTRL. Respiratory system compliance increased after HFPV. Conclusions: HFPV improved gas exchange in patients who did not respond to conventional treatment. This improvement remained unaltered until 12 h after the end of HFPV.

High-frequency percussive ventilation in severe acute respiratory distress syndrome: A single center experience

“…This is in accordance with both former[10] and recent[11] studies in adult ARDS patients demonstrating that HFPV significantly improved gas exchange at similar levels of mean airway pressure as in conventional ventilation. This effect occurred already within the 1 st h after initiation of HFPV and was sustained during the whole period of ventilation.…”

High frequency percussive ventilation increases alveolar recruitment in early acute respiratory distress syndrome: an experimental, physiological and CT scan study

“…HFPV has been used in neonates [ 8 ], burn patients [ 9 – 12 ], trauma patients [ 13 ] and patients with chronic obstructive lung disease [ 14 ]. HFPV has also been used in ARDS [ 15 ], or as rescue therapy [ 16 , 17 ]. Its theoretical properties include the delivery of low tidal volume ventilation with effective recruitment and enhanced secretion clearance [ 18 ].…”

“…Gases are administered through pulsatile Flow Ventilation TM Phasitron®, an open circuit device that is believed to adapt ventilation to patient lung volumes, regardless of compliance [ 19 ]. During HFPV, high frequency oscillatory diffusive ventilation is superimposed to conventional tidal volume convective ventilation, resulting in a rapid increase in arterial oxygenation [ 15 , 18 ]. However, despite positive effects on lung alveolar recruitment [ 18 ], hyperinflation might be induced by HFPV during ARDS, thus possibly limiting its use only as a rescue therapy in severe ARDS.…”

The Use of High-Frequency Percussive Ventilation for Whole-Lung Lavage: A Case Report

“…8 In a prospective study of 35 patients with acute respiratory distress syndrome, HFPV was associated with better oxygenation in patients who did not respond to conventional treatment compared with a historical control. 10 A retrospective data analysis of 42 patients with moderate and severe acute respiratory distress syndrome showed rapid and sustained improvement in oxygenation and ventilation after HFPV. 11 In a single-center, prospective, randomized controlled trial of 62 burn patients with respiratory failure, HFPV was associated with better oxygenation and ventilation, and with fewer patients requiring rescue ventilation compared with low tidal volume ventilation.…”