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Research ArticleOriginal Research

Evaluation of High-Frequency Oscillatory Ventilation as a Rescue Strategy in Respiratory Failure

Guramrinder Singh Thind, Umur Hatipoğlu, Robert L Chatburn, Sudhir Krishnan, Abhijit Duggal and Eduardo Mireles-Cabodevila
Respiratory Care August 2021, respcare.08936; DOI: https://doi.org/10.4187/respcare.08936
Guramrinder Singh Thind
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Ohio.
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Umur Hatipoğlu
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Ohio.
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Robert L Chatburn
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Ohio.
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Sudhir Krishnan
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Ohio.
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Abhijit Duggal
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Ohio.
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Eduardo Mireles-Cabodevila
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Ohio.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: The use of high-frequency oscillatory ventilation (HFOV) is backed by sound physiologic rationale, but clinical data on the elective use of HFOV have been largely disappointing. Nonetheless, HFOV is still occasionally used as a rescue mode in patients with severe hypoxemia. The evidence that supports this practice is sparse.

METHODS: This was a retrospective single-center analysis that involved subjects admitted to the medical ICU at Cleveland Clinic, Cleveland, Ohio. We included all adult patients (ages > 18 y) who received rescue HFOV between January 1, 2010, and December 31, 2018, and analyzed their clinical outcomes.

RESULTS: A total of 48 subjects were included in the analysis. The most common primary diagnosis was pneumonia (n = 33 [68.8%]), followed by aspiration (n = 6 [12.5%]) and diffuse alveolar hemorrhage (n = 2 [4.2%]). Switching to HFOV improved oxygenation but also increased vasopressor requirements at 3 h. The mortality rate of the study population was 92% (44/48).

CONCLUSIONS: Our study did not support utilization of HFOV as a “last-ditch” rescue measure in subjects with respiratory failure. The delayed timing of HFOV initiation and its detrimental hemodynamic effects are among the potential reasons for the high mortality rate.

  • HFOV
  • mechanical ventilation
  • ARDS
  • respiratory failure
  • VILI
  • rescue therapy

Footnotes

  • Correspondence: Eduardo Mireles-Cabodevila MD, Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44915. E-mail: mirelee{at}ccf.org
  • Copyright © 2021 by Daedalus Enterprises

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Respiratory Care: 67 (6)
Respiratory Care
Vol. 67, Issue 6
1 Jun 2022
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Evaluation of High-Frequency Oscillatory Ventilation as a Rescue Strategy in Respiratory Failure
Guramrinder Singh Thind, Umur Hatipoğlu, Robert L Chatburn, Sudhir Krishnan, Abhijit Duggal, Eduardo Mireles-Cabodevila
Respiratory Care Aug 2021, respcare.08936; DOI: 10.4187/respcare.08936

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Evaluation of High-Frequency Oscillatory Ventilation as a Rescue Strategy in Respiratory Failure
Guramrinder Singh Thind, Umur Hatipoğlu, Robert L Chatburn, Sudhir Krishnan, Abhijit Duggal, Eduardo Mireles-Cabodevila
Respiratory Care Aug 2021, respcare.08936; DOI: 10.4187/respcare.08936
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Keywords

  • HFOV
  • mechanical ventilation
  • ARDS
  • respiratory failure
  • VILI
  • rescue therapy

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