High-frequency oscillatory ventilation for adult respiratory distress syndrome-A pilot study

Abstract

To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to recruit and maintain optimal lung volume in patients with severe adult respiratory distress syndrome (ARDS). Surgical and medical intensive care units in a tertiary care, military teaching hospital. A prospective, clinical study. Seventeen patients, 17 yrs to 83 yrs of age, with severe ARDS (Lung injury Score of 3.81 +/- 0.23) failing inverse ratio mechanical conventional ventilation (PaO2/FIO2 ratio of 68.6 +/- 21.6, peak inspiratory pressure of 54.3 +/- 12.7 cm H2 O, positive end-expiratory pressure of 18.2 +/- 6.9 cm H2 O). High-frequency oscillatory ventilation was instituted after varying periods of conventional ventilation (5.12 +/- 4.3 days). We employed a lung volume recruitment strategy that consisted of incremental increases in mean airway pressure to achieve a PaO2 of >or=to60 torr (>or=to8.0 kPa), with an FIO2 of 47 (sensitivity 100%, specificity 100%) were associated with mortality. High-frequency oscillatory ventilation is both safe and effective in adult patients with severe ARDS failing conventional ventilation. A lung volume recruitment strategy during high-frequency oscillatory ventilation produced improved gas exchange without a compromise in DO2. These results are encouraging and support the need for a prospective, randomized trial of algorithm-controlled conventional ventilation vs. high-frequency oscillatory ventilation for adults with severe ARDS. (Crit Care Med 1997; 25:937-947)