title: High-frequency oscillatory ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  High-frequency oscillatory ventilation (HFOV) is usually considered not indicated for treatment of patients with chronic obstructive pulmonary disease (COPD) because of the theoretical risk of air trapping and hyperinflation. The aim of our study was to establish whether HFOV can be safely applied in patients with acute exacerbation of COPD and hypercapnic respiratory failure.
  
  
  METHODS
  Ten patients (age, 63-83 years) requiring intensive care treatment who failed on noninvasive ventilation were studied. After initial conventional mechanical ventilation (CMV) of less than 72 hours, all patients were transferred to HFOV for 24 hours and then back to CMV. Arterial blood gases, spirometry, and hemodynamic parameters were repeatedly obtained in all phases of CMV and HFOV at different settings. Regional lung aeration and ventilation were assessed by electrical impedance tomography.
  
  
  RESULTS
  High-frequency oscillatory ventilation was tolerated well; no adverse effects or severe hyperinflation and hemodynamic compromise were observed. Effective CO(2) elimination and oxygenation were achieved. Ventilation was more homogeneously distributed during HFOV than during initial CMV. Higher respiratory system compliance and tidal volume were found during CMV after 24 hours of HFOV.
  
  
  CONCLUSIONS
  Our study indicates that short-term HFOV, using lower mean airway pressures than recommended for acute respiratory distress syndrome, appears safe in patients with COPD while securing adequate pulmonary gas exchange.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany. frerichs@anaesthesie.uni-kiel.de
authors.forename: Inéz
authors.initials: I
authors.lastname: Frerichs
authors.forename: Ute
authors.initials: U
authors.lastname: Achtzehn
authors.forename: Andreas
authors.initials: A
authors.lastname: Pechmann
authors.forename: Sven
authors.initials: S
authors.lastname: Pulletz
authors.forename: Ernst W
authors.initials: EW
authors.lastname: Schmidt
authors.forename: Michael
authors.initials: M
authors.lastname: Quintel
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D006612:High-Frequency Ventilation / Q000009:adverse effects; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome