High-frequency oscillatory ventilation as a rescue therapy for adult trauma patients.
BACKGROUND
High-frequency oscillatory ventilation is an alternative ventilation mode that improves oxygenation in trauma patients in whom conventional ventilation strategies have been unsuccessful.


OBJECTIVE
To evaluate the effect of high-frequency oscillatory ventilation on oxygenation, survival, and parameters predictive of survival in trauma patients.


METHODS
A retrospective case series of 24 adult patients admitted to the trauma intensive care unit at a level I trauma center between November 2001 and July 2005 and treated with high-frequency oscillatory ventilation. Survivors and nonsurvivors were compared for mechanism and severity of injury, oxygenation parameters related to high-frequency oscillatory ventilation, and hospital course.


RESULTS
Of the 8577 patients admitted during the study period, acute respiratory distress syndrome developed in 103 (1%). Of those 103 patients, 24 (23%) were treated with high-frequency oscillatory ventilation. Most of the patients treated with high-frequency oscillatory ventilation had sustained blunt trauma (79%). Oxygenation parameters improved significantly with high-frequency oscillatory ventilation in all patients, regardless of survival. Of the 24 patients treated with this ventilation mode, 15 (62%) survived. Survival did not correlate with improved oxygenation parameters but with the number of failed organ systems and injury severity.


CONCLUSIONS
Although high-frequency oscillatory ventilation improves oxygenation, severity of traumatic injury and organ failure, not respiratory parameters, are predictors of survival. High-frequency oscillatory ventilation should be considered for pulmonary rescue of severely injured patients with acute respiratory distress syndrome.
Briggs
Steven
S
Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, North Carolina 27858-4354, USA.
Goettler
Claudia E
CE
Schenarts
Paul J
PJ
Newell
Mark A
MA
Sagraves
Scott G
SG
Bard
Michael R
MR
Toschlog
Eric A
EA
Rotondo
Michael F
MF
D001784:Blood Gas Analysis; D006612:High-Frequency Ventilation / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*