title: Use of HFPV for adults with ARDS: the protocolized use of high-frequency percussive ventilation for adults with acute respiratory failure treated with extracorporeal membrane oxygenation.
abstract: Historically, patients on extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome have received ventilatory "lung rest" with conventional or high-frequency oscillating ventilators. We present a series of adults treated with high-frequency percussive ventilation (HFPV) to enhance recovery and recruitment during ECMO. Adult respiratory patients, treated between January 2009 and December 2012 were cared for with a combination of standard ECMO practices and a protocol of recruitment strategies, including HFPV. Data are reported as mean ± standard error of the mean, percentage, or median. Comparisons are made by χ for categorical variables and by t-test and Mann-Whitney test for continuous variables. Significance is noted at the 95% confidence level (p < 0.05). There were 39 HFPV patients. They were 39.9 ± 2.2 years of age and had 3.0 ± 0.37 days of mechanical ventilation before the initiation of ECMO. Their pre-ECMO PaO2 to FiO2 ratio (PF ratio) was 52.3 ± 3.0 and their pCO2 was 50.22 ± 2.4. HFPV patients required a mean of 143.1 ± 17.6 hours and a median of 106 hours (range 45.75-350.25) of ECMO support and had a 62% survival to discharge. The post-ECMO PF ratio in the HFPV cohort was 301.8 ± 16.7. A protocolized practice of active recruitment that includes HFPV is associated with reduced duration of ECMO support in adults with respiratory failure.
authors: From the Legacy Emanuel Medical Center and Pacific Integration, Portland Oregon, University of Michigan Medical Center, Ann Arbor, Michigan.
authors: Andrew J
authors: AJ
authors: Michaels
authors: Jon G
authors: JG
authors: Hill
authors: Bernie P
authors: BP
authors: Sperley
authors: Brian P
authors: BP
authors: Young
authors: Tawyna L
authors: TL
authors: Ogston
authors: Connor L
authors: CL
authors: Wiles
authors: Peter
authors: P
authors: Rycus
authors: Tanya R
authors: TR
authors: Shanks
authors: William B
authors: WB
authors: Long
authors: Lori J
authors: LJ
authors: Morgan
authors: Robert H
authors: RH
authors: Bartlett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D055815:Young Adult