2003 OPEN FORUM Abstracts
High Frequency Oscillatory Ventilation in the Adult Population: A Case Series.
John Davies, MA RRT; Ai Ching Kor, MD; Michael Gentile, RRT; Ira Cheifetz, MD; Greg Ahearn, MD; Neil MacIntyre, MD; Duke University Medical Center, Durham, NC.
INTRODUCTION: High frequency oscillatory ventilation (HFOV) offers clinicians the ability to employ the "open lung" model at relatively high mean airway pressures while reducing peak airway pressures and, thereby, minimizing cyclic lung stretch. Our objective is to report our thirty-day mortality rate for adult acute respiratory distress syndrome (ARDS) patients managed with HFOV (using the 3100B Oscillator - Sensormedics , Palm Springs, CA) in comparison to previously published reports.
Methods: Data were collected from adult patients who received HFOV for ARDS at Duke University Medical Center. ARDS was defined as: bilateral infiltrates consistent with non-cardiogenic pulmonary edema, positive pressure ventilation requiring Paw > 20 cm H2O, FiO2 > .50 to maintain PaO2 55-80 torr, and no clinical evidence of left atrial hypertension.
RESULTS: Fifteen of twenty-three patients (65%) HFOV patients survived to at least 30 days from the initiation of HFOV. The following table compares our results with findings from similar studies.
|30 day mortality||35%||31%||37%||31% (3 mos)||53%||67%|
|# CV days pre-HFOV||4.4+29||2.7+2.7||7.2+4.6||5.12+4.3||5.7+5.6|
OI, oxygenation index; P/F, PaO2/FiO2.
CONCLUSION: Our findings compare favorably with the mortality rates of other studies of HFOV despite higher baseline APACHE scores. Earlier use of HFOV seems to correlate with decreased mortality which is consistent with neonatal and pediatric HFOV data. Our results augment the growing literature supporting the use of HFOV for adult patients with ARDS.
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