Category: Ventilation

High-Frequency Oscillatory Ventilation in Adults: Predictors of Mortality

Multivariate analysis identified OI at 24 h after HFOV initiation as the most significant posttreatment predictor of mortality. Derdak and colleagues also identified OI trend as the most significant posttreatment predictor of survival regardless of assigned ventilator, with the 16-h OI as the most discriminating time point. Fort and colleagues identified the fact that an OI of > 47 predicted mortality with a sensitivity and…

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High-Frequency Oscillatory Ventilation in Adults: HFOV Combined With Other Therapies

The observed pneumothorax rate (21.8%) is higher than the rates observed in studies evaluating conventional treatment strategies in adults with ARDS, in which barotrauma rates ranged from 7 to 14%. Derdak and colleagues reported pneumothorax rates of 9% and 12%, respectively, in the HFOV and CV groups. The higher rate in the current study was likely due to the patients’ severity of illness. Another possible…

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High-Frequency Oscillatory Ventilation in Adults: Hemodynamics

The 30-day mortality rate in the current study was 61.7%, which is higher than those in the studies by Fort et al and Derdak et al, despite similar APACHE II scores. The higher mortality rate in the current study may relate to patient parameters that are not captured in the APACHE II score, such as burn injury or organ/bone marrow transplantation. The higher mPaw applied…

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High-Frequency Oscillatory Ventilation in Adults: Discussion

The purpose of the current study was to summarize the experience with HFOV therapy in three Toronto medical/surgical ICUs. We observed the following. First, HFOV is used as rescue therapy in adults with ARDS due to a wide variety of etiologies, when patients are already requiring high Fio2 and/or high airway pressures. Second, the use of HFOV is associated with improvements in ventilation and oxygenation,…

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High-Frequency Oscillatory Ventilation in Adults: Patient Outcomes With HFOV

Fig3

Patient outcomes and the use of concomitant therapies for ARDS such as inhaled nitric oxide (NO) are presented in Table 2. The median duration of HFOV therapy in all patients was 3.5 days (25 to 75% CI, 0.8 to 6.8 days). Neuromuscular blocking agents were administered continuously during HFOV therapy to 90% of patients. Twenty-one percent of patients exhibited spontaneous respirations at some time during…

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High-Frequency Oscillatory Ventilation in Adults: HFOV Weaning and Transition to CV

Thirty-two patients (20.5%) had a pulmonary artery catheter during HFOV. At baseline, patients with a pulmonary artery catheter did not differ from those without a PA catheter with regard to age, acute physiology and chronic health evaluation (APACHE) II score, LIS, Fio2, Pao2/Fio2 ratio, OI, Paco2, ventilator pressures, or ventilator days prior to HFOV. Central venous pressure (CVP) increased immediately after starting therapy with HFOV…

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High-Frequency Oscillatory Ventilation in Adults: Results

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From January 1998 to February 2002, 156 patients with ARDS and severe hypoxemia underwent 171 trials of HFOV (Table 1). The mean (± SD) duration of ARDS prior to HFOV was 3.5 ± 4.3 days (median duration, 2 days; 25 to 75% confidence interval [CI], 0.2 to 5 days). The etiology of ARDS included sepsis (88 patients), pneumonia (26 patients), and aspiration of gastric contents…

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High-Frequency Oscillatory Ventilation in Adults: HFOV

HFOV was introduced into each center between 1998 and 1999. Data were extracted from the records of all patients who were treated at each center, from the time of introduction until January 2002. The data were reviewed by individuals not involved with data extraction, were entered into a database, and were screened for aberrant entries. Statistical analysis was performed in two prospectively defined steps. First,…

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High-Frequency Oscillatory Ventilation in Adults: Materials and Methods

In adults with ARDS, the experience with HFOV is limited to five observational studies and one randomized controlled trial. The observational studies reported significant improvements in oxygenation using an aggressive open lung strategy during HFOV, and the two larger studies suggested better outcomes when HFOV is applied early in the course of ARDS. Derdak and colleagues conducted a multicenter randomized, controlled trial comparing HFOV with…

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High-Frequency Oscillatory Ventilation in Adults

High frequency oscillatory ventilation (HFOV) is an alternative method of ventilation that theoretically achieves the goals of lung protective ventilation. During HFOV, gas exchange occurs through the application of a constant mean airway pressure (mPaw) that is usually higher than that applied during conventional ventilation (CV). Theoretically, HFOV may lead to improved alveolar recruitment while avoiding both the cyclic closing and opening of alveolar units…

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