HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (28) Citing Articles via Google Scholar Google Scholar Articles by Mehta, S. Articles by Stewart, T. E. Search for Related Content PubMed PubMed Citation Articles by Mehta, S. Articles by Stewart, T. E.

High-Frequency Oscillatory Ventilation in Adults^*

The Toronto Experience

^* From the Mount Sinai Hospital (Drs. Mehta and Stewart, and Mssrs. MacDonald and Bowman), Toronto; the University Health Network (Dr. Granton and Ms. Matte-Martyn), Toronto; Sunnybrook and Womens’ College Health Sciences Center (Dr. Smith), University of Toronto, Toronto, ON, Canada; and California State University (Mr. Bachman), San Bernardino, CA.

Correspondence to: Sangeeta Mehta, MD, Mount Sinai Hospital, 600 University Ave, No. 1818, Toronto, ON, Canada, M5G 1X5; e-mail: geeta.mehta{at}utoronto.ca

Study objectives: To review the clinical experience with high-frequency oscillatory ventilation (HFOV) in three medical-surgical ICUs in Toronto, ON, Canada, and to describe patient characteristics, HFOV strategies, and outcomes.

Design and patients: Retrospective chart review of all patients treated with HFOV at three academic university-affiliated ICUs since 1998. The data extracted included patient demographics, etiology of respiratory failure, ventilator settings, and gas exchange and cardiovascular data from baseline to 72 h of treatment, as well as at the transition from HFOV to conventional ventilation (CV). Heart rate and BP were recorded at regular intervals in all patients, and hemodynamic data were recorded in 32 patients who had pulmonary artery catheters in place. Cointerventions and ICU mortality were also recorded.

Measurements and results: A total of 156 adults (67 women and 89 men; mean [± SD] age, 48 ± 18 years; mean acute physiology and chronic health evaluation [APACHE] II score, 23.8 ± 7.5) with severe ARDS (ie, mean PaO₂/fraction of inspired oxygen [FIO₂] ratio, 91 ± 48 mm Hg; mean oxygenation index [OI], 31 ± 14) who had received CV for a duration of 5.6 ± 7.6 days underwent 171 trials of HFOV. HFOV was discontinued within 4 h in 19 patients (12%) because of difficulties with oxygenation, ventilation, or hemodynamics. PaO₂/FIO₂ ratios and OI ([FIO₂ x mean airway pressure x 100]/PaO₂) improved significantly with the application of HFOV, and this benefit persisted for the 72-h study duration. Significant changes in hemodynamics following HFOV initiation included an increase in central venous pressure and a reduction in cardiac output (throughout the 72 h), and an increase in pulmonary artery occlusion pressure (at 3 and 6 h). Patients were treated with HFOV for 5.1 ± 6.3 days. The 30-day mortality rate was 61.7%. Pneumothorax occurred in 21.8% of patients, 43.6% of patients were treated with inhaled nitric oxide, and 37.2% of patients were treated with steroids. Independent predictors of mortality on multivariate analysis were older age, higher APACHE II score, lower pH at the initiation of HFOV, and a greater number of days receiving CV prior to HFOV.

Conclusions: HFOV has beneficial effects on PaO₂/FIO₂ ratios and OI, and may be an effective rescue therapy for adults with severe oxygenation failure. The early institution of HFOV may be advantageous.

Key Words: ARDS • high-frequency oscillation • high-frequency ventilation • mechanical ventilation • respiratory failure

This article has been cited by other articles:

				C. N. Sessler and K. Varney Patient-Focused Sedation and Analgesia in the ICU Chest, February 1, 2008; 133(2): 552 - 565. [Abstract] [Full Text] [PDF]

				E. Fan, D. M. Needham, and T. E. Stewart Ventilatory Management of Acute Lung Injury and Acute Respiratory Distress Syndrome JAMA, December 14, 2005; 294(22): 2889 - 2896. [Abstract] [Full Text] [PDF]