Clinical surgery–AmericanHigh-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review
Section snippets
Materials and Methods
Parkland Memorial Hospital is associated with the University of Texas Southwestern Medical Center and serves as a level I trauma center for the city of Dallas. A retrospective review of our trauma registry for the period of January 2002 through December 2004 was performed to identify patients with ARDS managed with HFPV as an alternative mode of ventilation in severely hypoxic patients initially managed with conventional ventilation techniques. This study was approved by the Institutional
Results
Over the 24-month study period, 15 patients met inclusion criteria and their medical records were reviewed. Three patients with fewer than 3 respiratory data-collection points in 24 hours were excluded. All patients were cared for in the surgical intensive care unit. Mean length of intensive care unit stay was 26 days (range, 2 to 56 days). All surviving patients were transitioned back to conventional mechanical ventilation when oxygenation parameters improved. The mean age was 34 years. The
Comments
This study found that the use of HFPV in patients with ARDS after injury resulted in improved oxygenation parameters (OI and P/F) within the first 12 to 24 hours after conversion from conventional mechanical ventilation techniques. In addition, improvements in oxygenation were not secondary to an increase in mPaw.
Several prior studies have examined the effects of HFPV on patients with ARDS. These studies commonly focused on a heterogeneous population of medical and postoperative surgical
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Cited by (39)
Acute respiratory distress syndrome after chest trauma: Epidemiology, specific physiopathology and ventilation strategies
2019, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :HFPV mainly differs than HFO by the presence of two different steady pressure levels. The frequency of alternating between two pressure levels is usually fixed at 10−15/min, similar to conventional methods [62]. This cyclic variation of the airway pressure level limits the traditional adverse consequences induced by HFO.
Update in Management of Severe Hypoxemic Respiratory Failure
2017, ChestCitation Excerpt :Percussive breaths are purported to facilitate clearance of respiratory secretions, facilitate lung recruitment, and reduce the need for sedation.50 In observational studies, HFPV has been reported to improve oxygenation for patients with hypoxemic respiratory failure.51-54 One study reported less time on ECMO when HFPV was combined with ECMO.55
Initial commitment for inhalation injury
2013, Current Problems in SurgeryCitation Excerpt :Another group of patients where HFPV has generated interest is the ARDS population, in particular in association with trauma. The VDR may favorably affect oxygenation and ventilation when used as a salvage modality in this group of patients with ARDS.5,28-32 These clinical reports are limited by small sample size, retrospective constructs, lack of an adequate comparator (ideal body weight–defined protective ventilation), poorly defined criteria for patients who “fail” conventional modes, and conflicting results.
Reducing time on for extra-corporeal membrane oxygenation for adults with H1N1 pneumonia with the use of the Volume Diffusive Respirator
2013, American Journal of SurgeryCitation Excerpt :In animal models of aspiration and inhalation injury, HFPV has been shown to improve both oxygenation and carbon dioxide clearance while decreasing histologic evidence of lung injury and chemical evidence of inflammation.17–20 Clinical studies in burn and trauma patients have demonstrated improved oxygen indices, PaO2/FiO2 ratios, ventilation, and compliance relative to conventional ventilation modes in both retrospective observational reviews21–26 and prospective, randomized trials.27,28 The mechanisms by which HFPV improves oxygenation, recruits atelectatic segments, and mobilizes secretions without increasing VILI involve both the tidal respirations and the high-frequency, low-volume percussions.
A review of the utility of high-frequency oscillatory ventilation in burn and trauma ICU patients
2023, Current Opinion in Anaesthesiology