High-frequency oscillatory ventilation with and without arteriovenous extracorporeal lung assist in patients with severe respiratory failure.
OBJECTIVE
Elimination of carbon dioxide by an arteriovenous extracorporeal lung assist (av-ECLA) can facilitate the lung protective capabilities of high-frequency oscillatory ventilation (HFOV). This case series describes patients treated with HFOV because of severe respiratory failure with and without additional av-ECLA.


METHODS
A retrospective analysis of 31 patients regarding patient characteristics, gas exchange, respirator settings, hemodynamics, and outcome. In 18 patients, av-ECLA was started before, together with, or during HFOV.


RESULTS
The initial arterial carbon dioxide tension before HFOV and av-ECLA was higher in patients who received av-ECLA compared with patients without (P = .043): 65 (48-84) mm Hg and 50 (44-60) mmHg (median and interquartile range). The initial arterial oxygen tension (Pao(2))/inspiratory oxygen fraction (Fio(2)) index in patients who received av-ECLA was 79 (63-133) mm Hg. The Pao(2)/Fio(2) index immediately before HFOV was 84 (65-124) mm Hg (av-ECLA) and 121 (68-150) mmHg (no av-ECLA) and improved to 149 (89-231) mm Hg and 200 (117-233) mmHg during HFOV. Similarly, the oxygenation index improved. No statistically significant differences among groups were detected for Pao(2)/Fio(2) index, oxygenation index, and arterial carbon dioxide tension immediately before and during HFOV. The hospital mortality was 39% (av-ECLA) and 69% (no av-ECLA).


CONCLUSIONS
High-frequency oscillatory ventilation improved the oxygenation in patients with severe respiratory failure. Additional av-ECLA may facilitate using lung protective HFOV settings in more severe lung injury and hypercapnia.
Department of Anaesthesia and Critical Care, University of Würzburg, 97080 Würzburg, Germany. kredel_m@klinik.uni-wuerzburg.de
Markus
M
Kredel
Joerg
J
Brederlau
Christian
C
Wunder
Thomas E
TE
Wurmb
Peter
P
Kranke
Norbert
N
Roewer
Ralf M
RM
Muellenbach
D000328:Adult; D000368:Aged; D005112:Extracorporeal Circulation; D005260:Female; D006439:Hemodynamics; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome