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Hemodynamic effects of high-frequency oscillatory ventilation in acute respiratory distress syndrome
Critical Care volume 11, Article number: P198 (2007)
High-frequency oscillatory ventilation (HFOV) is a promising ventilatory modality for ARDS patients having refractory hypoxemia despite standard ARDS ventilation. Hemodynamic alterations while switching the patient from volume-controlled ventilation (VCV) to HFOV are not yet well studied.
To evaluate immediate (within 3 hours) hemodynamic effects of HFOV in ARDS patients with septic shock needing vasopressor support.
Patients having a PO2/FiO2 ratio ≤150, PEEP >12 cm and FiO2 requirement ≥0.7 on VCV (6 ml/kg) were switched to HFOV. The initial continuous distending pressure (CDP) of HFOV was 5 cm above the mean airway pressure during VCV. Other HFOV settings were FiO2 1, bias flow 30 l/min, amplitude 70 cm and frequency 7 Hz. The CDP was adjusted to maintain oxygen saturation >88%. Fluid bolus before switching to HFOV was avoided. All the patients were sedated and paralysed during the study period. A drop in the mean arterial pressure (MAP) ≤65 mm or cardiac index (CI) ≤2.5 l/min/m2 were treated with escalation of inotrope if required. Hemodynamic monitoring was done with the Flotrac-Vigileo monitoring system.
Eight ARDS patients needing vasopressor support were switched to HFOV from VCV. Baseline data of these patients were: age 58.87 ± 11.69 years, APACHE II score 21.02 ± 8.14, mean CDP of HFOV 26.67 ± 3.22 cm, frequency 7 Hz, amplitude 70 cm. Figure 1 presents the trends of hemodynamic parameters during the study period. Only one patient needed escalation of the dopamine dose during the trial period.
Switching of an ARDS patient from VCV to HFOV does not impart significant hemodynamic instabilities and can be safely done.
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Jog, S., Akole, P., Gadgil, S. et al. Hemodynamic effects of high-frequency oscillatory ventilation in acute respiratory distress syndrome. Crit Care 11, P198 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5358
- Mean Arterial Pressure
- Acute Respiratory Distress Syndrome
- Hemodynamic Effect
- Ventilatory Modality
- Fluid Bolus