2000 OPEN FORUM Abstracts
A RETROSPECTIVE COMPARISON OF UHFV vs CONVENTIONAL VENTILATION
Marie R. Milo, BBA, RRT, Vinod Puri, MD. Providence Hospital and Medical Centers, Southfield, MI
Background: High frequency ventilation has been used clinically for approximately 30 years. It has received scrutiny regarding its application and safety. The criteria for optimal use of ultrahigh frequency ventilation (UHFV) are still uncertain. In view of the reports of high mortality in adult respiratory distress syndrome (ARDS) ranging from 40-80% in most series we undertook a retrospective clinical review of patient data. The objective was to compare measurements of shunt, PaO2/FIO2 ratio (P/F), and PaO2/PAO2 ratio (a/A) before UHFV (during conventional ventilation) and 24 and 48 hours after the onset of UHFV. Mortality and incidents of complications were determined. Methods: Fifteen patients (8 women, 7 men) with a mean age of 53.5 years ±17.2 were included in this analysis. All patients in this study were placed on the Adult Star 1010 ventilator. Hemodynamic profiles were performed and the shunts, P/F ratios, and a/A ratios were extracted from this data. Results: The mean duration of conventional ventilation prior to UHFV was 24.7 ± 25.5 hrs.
|Pre UHFV||Post 24 hrs||Post 48 hrs|
|PaO2/FIO2||84.6 ± 38.0||219.5 ± 120.4 *||240.3 ± 83.6 *|
|Qs/Qt||41.6 ± 13.1||22.6 ± 7.8 *||25.2 ± 10.5 *|
|PaO2/PAO2||0.16 ± 0.11||0.35 ± 0.16 *||0.35 ± 0.13 *|
|* p<0.05 compared to pre level|
Mortality rate was 15.4%; only 1 complication (pneumothorax) was noted. Conclusions: Patient transition to UHFV in ARDS has historically been reviewed as late-stage, and near-futile intervention which has not served to reduce mortality. The current data suggests that early use of UHFV in ARDS improves oxygenation and may significantly reduce mortality and morbidity. Further study is warranted.