Resolution of organ functional scores to predict the outcome in adult acute respiratory distress syndrome patients receiving high-frequency oscillatory ventilation.
BACKGROUND
High-frequency oscillatory ventilation (HFOV) may be used as a rescue therapy for adults with acute respiratory distress syndrome who have failed conventional ventilation (CV). We undertook a prospective study to investigate the determinants of mortality and the sequential evolution of organ failures in HFOV-treated adult acute respiratory distress syndrome patients.


METHODS
The indication for HFOV was severe oxygenation failure (PaO2/FiO2 <120 mm Hg) while receiving aggressive CV support (defined by either PaO2 ≤65 mm Hg with FiO2 ≥0.6 when positive end-expiratory pressures >10 cmH2O or plateau airway pressure ≥35 cm H2O). Demographic, clinical, and physiologic data were collected prospectively (May 2007-July 2009). Organ System Failure (OSF), Sequential Organ Failure Assessment (SOFA), and Multiple Organ Dysfunction (MOD) scores were recorded during and after HFOV application. Additional outcome measures included HFOV successful weaning rate, cause of failure, complications, survival rate, and cause of death.


RESULTS
The intensive care unit mortality rate was 62% (21 of 34). Survivors had a significantly shorter CV time before HFOV than nonsurvivors (32.8 hours ± 16.7 hours vs. 47.9 hours ± 26.2 hours, p = 0.049). Survivors had significantly lower baseline lung injury scores, OSF, SOFA, and MOD scores than nonsurvivors. After HFOV, the OSF, SOFA, and MOD scores were significantly decreased for survivors, particularly from day 3 onward.


CONCLUSIONS
Survivors had early improvements in OSF scores after HFOV application. Organ failure system scoring may be used for deciding on HFOV initiation and for evaluating the effects of HFOV.
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Kuo-Chin
KC
Kao
Cheng-Ta
CT
Yang
Han-Chung
HC
Hu
Hui-Ching
HC
Ting
Ching-Tzu
CT
Huang
Lan-Ti
LT
Chou
Hsiu-Feng
HF
Hsiao
Li-Fu
LF
Li
Ying-Huang
YH
Tsai
Chung-Chi
CC
Huang
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D010101:Oxygen Consumption / Q000502:physiology; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D018570:Risk Assessment; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome; D015300:Ventilator Weaning