Use of High Frequency Percussive Ventilation in Inhalation Injuries

Abstract

Inhalation injury (II) causes significant morbidity and mortality, accounting for nearly 80% of non fire-related deaths and affecting nearly 25% of all patients hospitalized with thermal injury. High-frequency percussive ventilation (HFPV) has been reported to decrease both the incidence of pulmonary barotrauma and ventilator-associated pneumonia in II. It has evolved into a ventilatory modality promoted to rapidly remove airway secretions and improve survival. This manuscript presents the largest series of patients with II treated with HFPV to date. From 1998 to 2005, a total of 85 patients with inhalation injury were treated with HFPV. The diagnosis of II was made on admission based on the following clinical criteria: injury in a closed space, carbonaceous sputum, or positive bronchoscopy (presence of carbonaceous deposits, erythema or ulceration). HFPV was begun within 24 hours of injury. Each patient after mid-1998 received heparin and N-acetylcysteine via nebulization during therapy. The cohort of patients treated with HFPV had a mean age of 37 (r 0.4 - 73 yrs); mean TBSA and third degree burns were 30% & 21%, respectively. 130 patients with an II from the previous four years (1994–1997) treated with CMV were used as historical controls. Their mean age, TBSA and 3rd degree burns were 37 (r 0.3–87yrs), 36% and 27%, respectively. The average number of ventilator days, ICU days, and LOS between the HFPV and CMV groups was 21 vs. 22, (p=ns), 16 vs. 17.8 (p=ns) and 28 vs. 27, (p=ns) respectively. The incidence of ventilator associated pneumonia (VAP) in the HFPV & CMV groups was 33% & 29%, respectively. Barotrauma, as evidenced by incidence of spontaneous pneumothorax, was infrequent in both HFPV and CMV groups (2 vs. 9, respectively). Twenty six of 85 (31%) patients treated with HFPV and 56 of 130 with CMV (43%) died. (p=ns). Mortality among TBSA subsets 0–39%, 40–59%, and >60% TBSA did not reach statistical significance.