High-Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome in Adults

Abstract

Observational studies of high-frequency oscillatory ventilation in adults with the acute respiratory distress syndrome have demonstrated improvements in oxygenation. We designed a multicenter, randomized, controlled trial comparing the safety and effectiveness of high-frequency oscillatory ventilation with conventional ventilation in adults with acute respiratory distress syndrome; 148 adults with acute respiratory distress syndrome (Pa(O2)/fraction of inspired oxygen <or= 200 mm Hg on 10 or more cm H2O positive end-expiratory pressure) were randomized to high-frequency oscillatory ventilation (n = 75) or conventional ventilation (n = 73). Applied mean airway pressure was significantly higher in the high-frequency oscillation group compared with the conventional ventilation group throughout the first 72 hours (p = 0.0001). The high-frequency oscillation group showed early (less than 16 hours) improvement in Pa(O2)/fraction of inspired oxygen compared with the conventional ventilation group (p = 0.008); however, this difference did not persist beyond 24 hours. Oxygenation index decreased similarly over the first 72 hours in both groups. Thirty-day mortality was 37% in the high-frequency oscillation group and was 52% in the conventional ventilation group (p = 0.102). The percentage of patients alive without mechanical ventilation at Day 30 was 36% and 31% in the high-frequency oscillation and conventional ventilation groups, respectively (p = 0.686). There were no significant differences in hemodynamic variables, oxygenation failure, ventilation failure, barotraumas, or mucus plugging between treatment groups. We conclude that high-frequency oscillation is a safe and effective mode of ventilation for the treatment of acute respiratory distress syndrome in adults.

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

“…Previous trials evaluated continuous HFO [23,24], prone positioning [22,25,26] and high PEEP with/without RMs [27][28][29]. Positive findings comprised improved oxygenation [22,[24][25][26][27][28][29], improved respiratory mechanics [26,27,29], lower rates of refractory hypoxaemia [28,29], and more ventilatorfree and organ failure-free days [29].…”

“…Positive findings comprised improved oxygenation [22,[24][25][26][27][28][29], improved respiratory mechanics [26,27,29], lower rates of refractory hypoxaemia [28,29], and more ventilatorfree and organ failure-free days [29]. However, results on mortality were inconclusive.…”

Utilization Patterns And Patient Outcomes Associated With Use Of Rescue Therapies In Acute Lung Injury

“…One is that use of rescue therapy appears quite variable -comparison with other clinical trials and observational studies suggests large variations in rescue therapy utilization. Two, is that use of these therapies does not appear to be associated with clinical trial evidence for mortality outcomes -despite multiple randomized controlled trials that did not demonstrate mortality benefits to iNO,(26) prone positioning (27,28) and HFV (29) in ARDS contemporaneous to these studies, overall use of rescue therapies did not change. Three, utilization in those subjects with poor oxygenation and high airway pressures was in line with evidence that rescue therapies do improve oxygenation (25,29,30).…”

High-frequency oscillatory ventilation: What large-animal studies have taught us!

“…Many have simply recommended setting mean airway pressure equal to or a few centimeters of H 2 O above that used during CV (23)(24)(25). Goddon et al (26), in a 28 ± 5− kg lavage-injured sheep model investigated the use of the pressure-volume (P-V) curve to set mean airway pressure during HFO.…”