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High-frequency oscillatory ventilation for trauma patients with acute respiratory distress syndrome who fail conventional mechanical ventilation

Introduction

The purpose of this study is to report our clinical experience with high-frequency oscillatory ventilation (HFOV) for rescuing trauma patients with acute respiratory distress syndrome (ARDS) and severe hypoxemia despite optimal conventional ventilation. Experimental and clinical data suggest mechanical ventilation can contribute to mortality in ARDS, and modern ventilatory strategies require protective measures such as low tidal volume, low airway pressure and fraction of inspired oxygen (FIO2), which is not always possible with conventional ventilation. HFOV could be an alternative to achieve protective ventilation and adequate oxygenation.

Methods

We retrospectively analyzed nine trauma patients who presented with ARDS criteria and failed conventional mechanical ventilation requiring HFOV. The mean airway pressure was initially set 3–5 cmH2O higher than that for conventional ventilation and was subsequently adjusted to maintain oxygen saturation >90% and FiO2 <0.6. The PaCO2 target range was 35–60 mmHg with a pH >7.25. We collected demographic data, injury severity scale (ISS), APACHE II score, time to HFOV, time spent on HFOV, ventilation settings and arterial blood gas before and after HFOV and mortality.

Results

Data on nine trauma patients were available for analysis; the severity of respiratory dysfunction can be estimated by the mean PaO2/FiO2 of our patients, 131. Two patients received a trial of inhaled nitric oxide as part of the management of ARDS failing conventional ventilation. The last mean measurements before initiation of HFOV were: pH 7.24, PaO2 116, PCO2 67.4, FiO2 0.899. No significant hemodynamic instability was associated with initiation and administration of HFOV. The mean frequency was 4.3 (mode 4), mean power was 8.5, mean FiO2 was 0.83. The successful weaning rate from HFOV to extubation or trach mask was 70%, and mean total time of mechanical ventilation (conventional + HFOV) was 347.76 hours and the time spent on HFOV was 107.5 hours.

Conclusion

HFOV is a possible alternative for safely correcting oxygenation failure associated with ARDS in trauma patients. Further research is necessary to identify the best strategy and patients for HFOV.

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Eng, F., Ferri, M., Rizoli, S. et al. High-frequency oscillatory ventilation for trauma patients with acute respiratory distress syndrome who fail conventional mechanical ventilation. Crit Care 11, P197 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5357

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Keywords

  • Nitric Oxide
  • Trauma Patient
  • Airway Pressure
  • Acute Respiratory Distress Syndrome
  • Conventional Mechanical Ventilation