Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome*

Hager, David N.; Fessler, H; Kaczka, David W.; Shanholtz, Carl; Fuld, Matthew K.; Simon, Brett A.; Brower, Roy G.

doi:10.1097/01.ccm.0000266586.04676.55

Cited by 95 publications

(62 citation statements)

References 33 publications

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“…Similar inconclusive results have been seen in neonates, although the pathophysiology for neonatal respiratory distress syndrome is quite unique from adult and pediatric ALI/ ARDS (46). However, Hager and associates have made important observations concerning the relative contributions of oscillator frequency and amplitude (47) and argue that HFOV can be made even more lung protective if larger amplitudes are used for CO 2 removal while prioritizing increases in frequency (and thus reducing the often considerable delivered VT at lower hertz) (25). Adult intensivists have designed protocols incorporating these priorities (24) that are quite different from pediatric practice in which amplitude is limited and frequency is reduced with consequent larger VTs (48).…”

Section: Hfovmentioning

confidence: 99%

The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

Khemani

Newth

2010

Am J Respir Crit Care Med

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Pediatric practitioners face unique challenges when attempting to translate or adapt adult-derived evidence regarding ventilation practices for acute lung injury or acute respiratory distress syndrome into pediatric practice. Fortunately or unfortunately, there appears to be selective adoption of adult practices for pediatric mechanical ventilation, many of which pose considerable challenges or uncertainty when translated to pediatrics. These differences, combined with heterogeneous management strategies within pediatric critical care, can complicate clinical practice and make designing robust clinical trials in pediatric acute respiratory failure particularly difficult. These issues surround the lack of explicit ventilator protocols in pediatrics, either computer or paper based; differences in modes of conventional ventilation and perceived marked differences in the approach to high-frequency oscillatory ventilation; challenges with patient recruitment; the shortcomings of the definition of acute lung injury and acute respiratory distress syndrome; the more reliable yet still somewhat unpredictable relationship between lung injury severity and outcome; and the reliance on potentially biased surrogate outcome measures, such as ventilator-free days, for all pediatric trials. The purpose of this review is to highlight these challenges, discuss pertinent work that has begun to address them, and propose potential solutions or future investigations that may help facilitate comprehensive trials on pediatric mechanical ventilation and define clinical practice standards.

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Section: Hfovmentioning

confidence: 99%

The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

Khemani

Newth

2010

Am J Respir Crit Care Med

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“…With these settings, the delivered V T is often below the anatomic dead space (1-3 mL/kg of predicted body weight). 45 Some authors recommend increasing the oscillation frequency as much as possible to minimize V T and alveolar cyclic pressures. 47 Before initiating HFOV, a recruitment maneuver is often recommended to reopen collapsed alveoli, allowing the relatively high P aw to maintain the recruited lung.…”

Section: High-frequency Oscillatory Ventilation Basic Principlesmentioning

confidence: 99%

Airway Pressure Release Ventilation and High-Frequency Oscillatory Ventilation: Potential Strategies to Treat Severe Hypoxemia and Prevent Ventilator-Induced Lung Injury

Facchin

Fan

2015

Respir Care

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“…During HFO, tidal volumes of ,3.5 mL?kg -1 predicted body weight are administered at o3 Hz and mean airway pressure (P aw) ranges 22-40 cmH 2 O [1][2][3]. Animal lung injury data favour HFO over lung-protective conventional mechanical ventilation (CMV) [4].…”

mentioning

confidence: 99%

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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Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome*

Cited by 95 publications

References 33 publications

The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

Airway Pressure Release Ventilation and High-Frequency Oscillatory Ventilation: Potential Strategies to Treat Severe Hypoxemia and Prevent Ventilator-Induced Lung Injury

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

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