[Superimposed high-frequency jet ventilation (SHFJV) in the administration of NO. Technical basis and early clinical results with ARDS].
The mortality of patients with acute respiratory distress syndrome (ARDS) is still above 50% despite continuous progress in intensive care medicine. Recent therapy regimens such as the extra corporeal life support (ECLS), permissive hypercarbia, high-frequency ventilation techniques and inhaled nitric oxide (NO) are being applied. All of the above techniques are aimed at different parts of the problems caused by ARDS. This study was designed to evaluate the possible additive benefits of superimposed high-frequency jet ventilation (SHFJV) and inhaled NO. METHODS. In experiments on a lung simulator it was demonstrated that it is possible to administer exact amounts of NO using a computer-controlled system with a feedback loop (Pulmonox) using the SHFJV. Applying the therapeutic reference point of 20 ppm of NO, the deviation was +/- 3 ppm at this setting. CASE REPORT. After successfully concluding our experiments, this combined therapy concept was applied in a patient with terminal ARDS. Under CMV, paO2 was 69.4 mm Hg and the oxygen saturation 88.3% with a F1O2 of 1.0. Significant improvement was observed within 30 min after starting SHFJV with inhaled NO (paO2 282.9 mm Hg; oxygen saturation 99.5%). There were no differences observed in hemodynamic parameters between CMV and SHFJV. Although the pulmonary status of the patient improved, the patient died due to therapy-resistant hemodynamic failure. CONCLUSION. It will take further studies to judge whether the success of this new ventilation strategy is reproducible and if the improvement of the oxygenation is more pronounced when adding inhaled NO to SHFJV than when each technique is applied separately.
Schragl
E
E
Klinik für Anästhesie und Allgemeine Intensivmedizin, Universität Wien.
Donner
A
A
Kashanipour
A
A
Ullrich
R
R
Aloy
A
A
D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D017809:Fatal Outcome; D006439:Hemodynamics / Q000502:physiology; D006612:High-Frequency Ventilation / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D009609:Nitrous Oxide / Q000008:administration & dosage; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*
D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide