Abstract
BackgroundHigh-frequency oscillatory ventilation (HFOV) was introduced in our institution in June 2003. Since then, there has been no protocol to guide the use of HFOV, and all decisions regarding ventilation strategies and settings of HFOV were made by the treating intensivist. The aim of this study is to report our first year of experience using HFOV.MethodsIn this retrospective study, we reviewed all 14 adult patients, who were consecutively ventilated with HFOV in the intensive care units of a tertiary medical center, from June 2003 to July 2004.ResultsThe mean age of the patients was 56 years, 10 were males, and all were whites. The first day median APACHE II score and its predicted hospital mortality were 35 and 83%, respectively, and the median SOFA score was 11.5. Eleven patients had ARDS, two unilateral pneumonia with septic shock, and one pulmonary edema. Patients received conventional ventilation for a median of 1.8 days before HFOV. HFOV was used 16 times for a median of 3.2 days. Improvements in oxygenation parameters were observed after 24 hours of HFOV (mean PaO2/FIO2 increased from 82 to 107, P < 0.05; and the mean oxygenation index decreased from 42 to 29; P < 0.05). In two patients HFOV was discontinued, in one because of equipment failure and in another because of severe hypotension that was unresponsive to fluids. No change in mean arterial pressure, or vasopressor requirements was noted after the initiation of HFOV. Eight patients died (57 %, 95% CI: 33–79); life support was withdrawn in six and two suffered cardiac arrest.ConclusionDuring our first year of experience, HFOV was used as a rescue therapy in very sick patients with refractory hypoxemia, and improvement in oxygenation was observed after 24 hours of this technique. HFOV is a reasonable alternative when a protective lung strategy could not be achieved on conventional ventilation.
Highlights
High-frequency oscillatory ventilation (HFOV) was introduced in our institution in June 2003
High-frequency oscillatory ventilation (HFOV) is a mode of mechanical ventilation in which gas exchange is achieved by oscillatory swings of airway pressure around a constant mean airway pressure (usually higher than that applied during conventional ventilation (CV)), through the rapid (3–15 Hertz) delivery of subnormal tidal volumes [1,2]
A renewed interest in HFOV has emerged in recent years, because animal data support the concept of reduced lung injury using this technique when assessed by several surrogate physiologic endpoints [1,3]; and because lung protection can be provided by a ventilatory strategy that limits both pulmonary overdistension and collapse of alveolar units [4,5]
Summary
High-frequency oscillatory ventilation (HFOV) was introduced in our institution in June 2003. Based on the encouraging findings with HFOV in animal models, several trials were undertaken in neonatal and pediatric patients [6,7,8,9,10,11]. None of these trials have shown a significant mortality benefit, a recent metaanalysis published by the Cochrane library in preterm infants suggested that there may be a small reduction in the rate of chronic lung disease associated with the elective use of HFOV versus CV. The aim of this study is to review our first year of experience using HFOV in adult patients
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