High frequency oscillatory ventilation for surgical patients with acute respiratory distress syndrome.
BACKGROUND
Numerous studies have suggested that high-frequency oscillatory ventilation (HFOV) used as rescue therapy may improve oxygenation in acute respiratory distress syndrome (ARDS) patients. The purpose of this study is to analyze the efficacy and safety of HFOV in surgical patients with ARDS.


METHODS
A total of 16 surgical ARDS patients with severe oxygenation failure received HFOV, despite aggressive conventional mechanical ventilatory support. Mean airway pressure was initially set 3 to 5 cm H2O higher than that for conventional ventilation and was subsequently adjusted to maintain oxygen saturation > or = 90% and FiO2 < or =0.6. Oxygenation, ventilation, and hemodynamic parameters were measured during conventional ventilation before initiating HFOV and during HFOV support for a total of 40 hours. Other outcome measures included duration of HFOV, successful weaning rate, cause of failure, complications, survival rate, and cause of death.


RESULTS
There was a considerable increase in Pao2/FiO2 ratio after 30 minutes, and this increase was maintained after 12 hours of HFOV throughout the study. There was a significant decrease in oxygenation index after 24 hours of HFOV support. There was no significant change in blood pressure associated with initiation and administration of HFOV. The successful weaning rate from HFOV to conventional ventilation was 75%. The intensive care unit survival rate was 43.8% and hospital survival rate was 37.5%.


CONCLUSIONS
High-frequency oscillatory ventilation was effective and safe in correcting oxygenation failure associated with ARDS in surgical patients. Future research is warranted to identify the suitable patients, timing, and optimal strategy for applying HFOV.
Kao
Kuo-Chin
KC
Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Tsai
Ying-Huang
YH
Wu
Yao-Kuang
YK
Huang
Ching-Tzu
CT
Shih
Mei-Ju
MJ
Huang
Chung-Chi
CC
D000328:Adult; D001794:Blood Pressure; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*