The Science Journal of the American Association for Respiratory Care

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. 

Baseline Duke ARDSnet1 MOAT2 Anderson3 Fort4 Mehta5
n 23 432 75 16 17 24
Age (yrs) 39+39 51+17 48+17 38.2+17.5 38+20.4 48.5+15.2
APACHE II 29+14   22+6 26.6+4.3 23.31+7.51 21.5+6.9
P/F ratio 82+95 138 114+37 91.5+24 66.1+19.0 98.8+39
OI 32+52 12 24+15 28.1+12.6 48.6+15.2 32.5+19.6
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. 

1. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000. 

2. Derdak et al. High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: A randomized, controlled trial. Am J Respir Crit Care Med. 2002. 

3. Anderson et al. High frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome - A retrospective study. Acta Anaesthesiol Scand. 2002. 

4. Fort et al. High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study. Crit Care Med. 1997. 

5. Mehta et al. Prospective trial of high-frequency oscillation in adults with acute respiratory distress syndrome. Crit Care Med. 2001

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