The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

HFOV IN ADULTS WITH SEVERE ARDS: AN OUTCOME ANALYSIS

Kimberly Bauser RRT; Carl Haas MLS RRT FAARC; Susan Henning RRT; Gary Martin BS RRT; Lena Napolitano MD FACS FCCM.  Critical Care Support Services and the Department of Surgery, University of Michigan Hospitals & Health Centers; Ann Arbor MI

Background: After review of the literature and consultation with current users, we recently developed a HFOV protocol for adult patients with severe ARDS failing conventional lung protective ventilation strategies, many were evaluated for ECMO.  Study

Objective:
To review patient outcomes associated with HFOV treatment in severe ARDS.  Study Design: A retrospective review of patients treated with HFOV from July 2005 through May 2006. Data collected included: patient demographics, etiology of respiratory failure (pulmonary vs. extra-pulmonary insult), ventilator settings, arterial blood gases, incidence of pneumothorax, whether ECMO and or nitric oxide were used in conjunction with HFOV, and hospital mortality. Values for FiO2, PaO2, PaCO2, pH, mean airway pressure, PaO2/FiO2 ratio and oxygen index were measured or calculated before HFOV application (pre), and at 1, 12, 24 and 48 hours following HFOV initiation.  

Results:
We treated 21 patients (15 males) with a mean age of 40 ±18 yrs. Two patients were on ECMO before initiating HFOV and another 3 patients were placed on ECMO while receiving HFOV. One patient recieved inhaled nitric oxide (iNO) before and 2 during HFOV. Overall mortality was 52.4% (11/21).  All-cause mortality associated with ARDS etiology and other interventions are: pulmonary 61.5% (8/13), extra-pulmonary 37.5% (3/8), pneumonia 75% (6/8), sepsis 33.3% (2/6), trauma 33.3% (1/3), 'other' etiology 50% (2/4), developed a new pneumothorax 50% (2/4), without a new pneumothorax 50% (8/16), requiring ECMO 60% (3/5), and received iNO 80% (4/5). Measures for P/F ratio, oxygenation index and PaCO2 are (mean (SD):



Conclusion: Survivors had improved oxygenation within 12 hours after initiating HFOV, and further improvement at 48 hours. Non-survivors had less of an improvement at hour-12, and no further improvement. Patients with extra-pulmonary ARDS had a lower mortality rate. HFOV was found to be a safe and effective alternative to conventional ventilation when lung protective strategies could not be achieved in adult patients with severe ARDS.  This study adds to the support for a randomized, controlled, multi center trial of HFOV in adult patients with severe ARDS.

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