Combination of high frequency oscillatory ventilation and interventional lung assist in severe acute respiratory distress syndrome.
BACKGROUND
The combination of high-frequency oscillatory ventilation (HFOV) and extracorporeal carbon dioxide removal with the interventional lung assist (iLA) in severe acute respiratory distress syndrome (ARDS) represents a novel treatment option.


METHODS
The study used a retrospective single-center analysis of 21 consecutive adult patients with severe ARDS, ventilated with HFOV/iLA. Efficiency, side effects, and outcome of combined treatment are presented as median (interquartile range).


RESULTS
The following were used to determine patient characteristics: sequential organ failure assessment score, 14; simplified acute physiology score II, 41; and Murray score, 4. The duration of combined treatment was 6 days. The blood flow through the iLA was 1.9 L/min. The Pao(2)/inspired fraction of oxygen ratio increased from 61 (47-86) to 98 (67-116) within 2 hours and to 106 (70-135) mm Hg at 24 hours. Paco(2) decreased from 58 (50-76) to 37 (29-47) mm Hg at 2 hours with normalization of pH 7.28 (7.16-7.36) to 7.43 (7.33-7.49) after 2 hours associated with hemodynamic stabilization. In 6 patients, complications due to iLA treatment were observed, and in 3 patients, complications associated with HFOV were seen. Weaning from HFOV/iLA was successful in 10 patients. The 30-day mortality rate was 43%, and hospital mortality rate was 57%.


CONCLUSIONS
The combination of HFOV/iLA is an option in severe pulmonary failure if conventional ventilation fails and pumpdriven extracorporeal membrane oxygenation therapy is not available.
Lubnow
Matthias
M
Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany. matthias.lubnow@klinik.uni-regensburg.de
Luchner
Andreas
A
Philipp
Alois
A
Buchner
Stefan
S
Jeron
Andreas
A
Karagiannidis
Christian
C
Bein
Thomas
T
Pawlik
Michael
M
Jungbauer
Carsten
C
Schmid
Christof
C
Riegger
Günter A J
GA
Pfeifer
Michael
M
Müller
Thomas
T
D000328:Adult; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006612:High-Frequency Ventilation; D017052:Hospital Mortality; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D000860:Hypoxia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome