title: Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome.
abstract: In acute respiratory distress syndrome (ARDS), recruitment sessions of high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) with short-lasting recruitment manoeuvres (RMs) may improve oxygenation and enable reduction of subsequent conventional mechanical ventilation (CMV) pressures. We determined the effect of adding HFO-TGI sessions to lung-protective CMV on early/severe ARDS outcome. We conducted a prospective clinical trial, subdivided into a first single-centre period and a second two-centre period. We enrolled 125 (first period, n = 54) patients with arterial oxygen tension (P(a,O(2)))/inspiratory oxygen fraction (F(I,O(2))) of <150 mmHg for >12 consecutive hours at an end-expiratory pressure of ≥ 8 cmH(2)O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n = 61) or CMV group (receiving lung-protective CMV and RMs; n = 64). The primary outcome was survival to hospital discharge. Pre-enrolment ventilation duration was variable. During days 1-10 post-randomisation, P(a,O(2))/F(I,O(2))), oxygenation index, plateau pressure and respiratory compliance were improved in the HFO-TGI group versus the CMV group (p < 0.001 for group × time). Within days 1-60, the HFO-TGI group had more ventilator-free days versus the CMV group (median (interquartile range) 31.0 (0.0-42.0) versus 0.0 (0.0-23.0) days; p < 0.001), and more days without respiratory, circulatory, renal, coagulation and liver failure (p ≤ 0.003). Survival to hospital discharge was higher in the HFO-TGI group versus the CMV group (38 (62.3%) out of 61 versus 23 (35.9%) out of 64 subjects; p = 0.004). Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.
authors: First Dept of Intensive Care Medicine, University of Athens Medical School, Athens, Greece. sdmentzelopoulos@yahoo.com
authors: S D
authors: SD
authors: Mentzelopoulos
authors: S
authors: S
authors: Malachias
authors: E
authors: E
authors: Zintzaras
authors: S
authors: S
authors: Kokkoris
authors: E
authors: E
authors: Zakynthinos
authors: D
authors: D
authors: Makris
authors: E
authors: E
authors: Magira
authors: V
authors: V
authors: Markaki
authors: C
authors: C
authors: Roussos
authors: S G
authors: SG
authors: Zakynthinos
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006612:High-Frequency Ventilation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007327:Insufflation / Q000295:instrumentation / Q000379:methods*; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D013534:Survival; D016896:Treatment Outcome
chemical_list: D010100:Oxygen