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. 2010 Sep;25(3):436-44.
doi: 10.1016/j.jcrc.2009.11.004. Epub 2010 Jan 15.

Combination of high frequency oscillatory ventilation and interventional lung assist in severe acute respiratory distress syndrome

Matthias Lubnow  1 , Andreas Luchner, Alois Philipp, Stefan Buchner, Andreas Jeron, Christian Karagiannidis, Thomas Bein, Michael Pawlik, Carsten Jungbauer, Christof Schmid, Günter A J Riegger, Michael Pfeifer, Thomas Müller
Affiliations

Combination of high frequency oscillatory ventilation and interventional lung assist in severe acute respiratory distress syndrome

Matthias Lubnow et al. J Crit Care. 2010 Sep.

Abstract

Background: The combination of high-frequency oscillatory ventilation (HFOV) and extracorporeal carbon dioxide removal with the interventional lung assist (iLA) in severe acute respiratory distress syndrome (ARDS) represents a novel treatment option.

Methods: The study used a retrospective single-center analysis of 21 consecutive adult patients with severe ARDS, ventilated with HFOV/iLA. Efficiency, side effects, and outcome of combined treatment are presented as median (interquartile range).

Measurements and main results: The following were used to determine patient characteristics: sequential organ failure assessment score, 14; simplified acute physiology score II, 41; and Murray score, 4. The duration of combined treatment was 6 days. The blood flow through the iLA was 1.9 L/min. The Pao(2)/inspired fraction of oxygen ratio increased from 61 (47-86) to 98 (67-116) within 2 hours and to 106 (70-135) mm Hg at 24 hours. Paco(2) decreased from 58 (50-76) to 37 (29-47) mm Hg at 2 hours with normalization of pH 7.28 (7.16-7.36) to 7.43 (7.33-7.49) after 2 hours associated with hemodynamic stabilization. In 6 patients, complications due to iLA treatment were observed, and in 3 patients, complications associated with HFOV were seen. Weaning from HFOV/iLA was successful in 10 patients. The 30-day mortality rate was 43%, and hospital mortality rate was 57%.

Conclusion: The combination of HFOV/iLA is an option in severe pulmonary failure if conventional ventilation fails and pumpdriven extracorporeal membrane oxygenation therapy is not available.

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