High frequency oscillatory ventilation in burn patients with the acute respiratory distress syndrome.
BACKGROUND
High frequency oscillatory ventilation (HFOV) improves gas exchange while providing lung protective effects during the ventilation of patients with the acute respiratory distress syndrome (ARDS). The purpose of this study was to review our experience with HFOV in adult burn patients with oxygenation failure secondary to ARDS.


METHODS
Retrospective cohort review of all burn patients treated with HFOV at a regional adult burn center.


RESULTS
All values are reported as the mean +/- standard deviation (S.D.). HFOV was used on 28 occasions in 25 patients (age 44 +/- 16 years, %TBSA burns 40 +/- 15, and a 28% incidence of inhalation injury) who had severe oxygenation failure from ARDS (PaO2/FiO2 ratio 98 +/- 26, and oxygenation index (OI) (FiO2 x 100 x mean airway pressure/PaO2) 27 +/- 10) following 4.8 +/- 4.4 days of conventional mechanical ventilation (CMV). After switching from CMV to HFOV, there were significant improvements in the PaO(2)/FiO2 ratio within 1h and in the oxygenation index within 24 h. The duration of HFOV was 6.1 +/- 5.8 days. HFOV was continued during 26 surgeries for 14 patients where a mean of 18 +/- 9% TBSA burns were excised and closed. The only complications related to HFOV were three episodes of severe hypercapnia. In-hospital mortality was 32%.


CONCLUSIONS
HFOV was safe, and was highly effective in correcting oxygenation failure associated with ARDS in burn patients, and can be successfully used as an intra-operative ventilation modality for burn patients.
Cartotto
Robert
R
Room D710, Ross Tilley Burn Center, Sunnybrook and Womens' College Health Sciences Center, 2075 Bayview Avenue, Toronto, Ont., Canada M4N 3M5. robert.cartotto@sw.ca
Ellis
Sandi
S
Gomez
Manuel
M
Cooper
Andrew
A
Smith
Terry
T
D000328:Adult; D000403:Airway Resistance; D002056:Burns / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D002059:Burns, Inhalation / Q000150:complications / Q000503:physiopathology; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D010313:Partial Pressure; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors
D010100:Oxygen