High frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome--a retrospective study

Abstract

Background: At present there are limited data about the effects of high frequency oscillatory ventilation (HFOV) in adult patients with acute respiratory distress syndrome (ARDS). This study evaluates efficacy of HFOV in such patients.

Methods: Sixteen ARDS patients, mean age 38.2 years (range 18-76), that underwent HFOV between 1997 and 2001 were enrolled in the study and evaluated in retrospect. FIo2, arterial blood gases, mean airway pressure (mean Paw), blood pressure, heart rate and central venous pressure were recorded by 4, 8, 12, 24, 48 and 72 h of HFOV and compared to conventional mechanical ventilation (CMV) at baseline (4 h prior to HFOV).

Results: On admission to the ICU, mean Simplified Acute Physiology score (SAPS II) was 40.3 (SD 12.6). Main causes of ARDS were pneumonia (9/16) and burn injuries (4/16). At baseline the patients had severe ARDS as noted by a mean lung injury score (LIS) of 3.2 (SD 0.3) and Pao2/FIo2 ratio 12.2 (SD 3.2) kPa. Within 4 h of HFOV, Pao2/FIo2 increased to 17.3 (SD 5.9) kPa (P = 0.016). Throughout HFOV, Pao2/FIo2 was significantly higher than at baseline. There were no significant changes in haemodynamic parameters. Ending HFOV after 6.6 (SD 3.2) days, survivors (n = 11) significantly reduced their Sequential Organ Failure Assessment Score (SOFA) compared to baseline. Survival at 3 months was 68.8%.

Conclusion: HFOV effectively improves oxygenation without haemodynamic compromise. During HFOV, the SOFA score may predict outcome.