2011 OPEN FORUM Abstracts
A COMPARISON OF INITIATION POINTS OF HIGH FREQUENCY OSCILLATORY VENTILATION ON MORTALITY RATES IN PATIENTS WITH EXTRAPULMONARY CAUSES OF ACUTE RESPIRATORY DISTRESS SYNDROME.
Daniel P. Rausch, Reid Ikeda; Respiratory Care Services, The Queen's Medical Center, Honolulu, HI
BACKROUND: One year after the introduction of high frequency oscillatory ventilation (HFOV) for acute respiratory distress syndrome (ARDS), a retrospective review examining the effectiveness of HFOV in the treatment of pulmonary and extrapulmonary causes of ARDS was published in an abstract in Respiratory Care in 2009. HFOV implementation was evaluated by the same respiratory therapist with strict inclusion and exclusion criteria used in the Multicenter Oscillatory Ventilation for ARDS Trial (MOAT)1: Diagnosis of ARDS, pulmonary artery catheter wedge pressure < 18 and a mean airway pressure (MAP) of 24 on conventional ventilation. During the first year 7 patients with extrapulmonary causes of ARDS (predicted APACHE II mortality 49.5%) were evaluated with the results shown in Table 1. Unlike the group of patients with pulmonary causes of ARDS, predicted mortality did not decrease using the original criteria. In 2010 the starting point for HFOV was lowered to a MAP of 20, while other criteria remained the same. METHODS: A retrospective review was conducted comparing predicted and actual mortality, total ventilator days on conventional ventilation, days on HFOV, and intensive care unit (ICU) and hospital length of stay (LOS) of the two groups with extrapulmonary causes of ARDS at different HFOV initiation points. CONCLUSION: In this small sample the third year group with a starting MAP of 20 had a 20% higher predicted mortality, but actual mortality was 24% lower. Total ventilator days, ICU and hospital LOS were actually higher in the third year group. The longer ICU and hospital LOS were attributable to 2 patients with multiple comorbidities who had an average ICU and hospital LOS of 42 and 150 days. These findings suggest that initiating HFOV for extrapulmonary causes of ARDS at a lower MAP may have a positive impact on predicted mortality, but may not decrease ICU or hospital LOS. Reference 1. Derdak S et al for the MOAT Study Group. High Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome: a randomized, controlled trial. Am J Resp Crit Care Med Vol 166. pp. 801-808, (2002)
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