High frequency percussive ventilation and conventional ventilation after smoke inhalation: a randomised study
Introduction
Inhalation injury represents a dramatic complication in thermally injured patients, increasing morbidity and mortality [1], [16] by predisposing to the development of bacterial pneumonias. It frequently causes progressive respiratory insufficiency leading to acute respiratory failure [3].
Current treatment modalities for respiratory insufficiency from inhalation injury include support with artificial conventional ventilation (CV; volume-cycled positive pressure ventilators) associated with supplemented oxygen, frequent tracheo-bronchial toilet and anti-microbial therapy [1], [16].
Unfortunately, CV support fails in many cases, leading to excessive ventilatory pressures and possible occurrence of volutrauma or barotrauma, lack of elimination of carbon dioxide or insufficient blood oxygenation [1], [3].An interesting alternative to CV support methods is high frequency percussive ventilation (HFPV), which is a recent form of high frequency ventilation administered by a volumetric diffusive respirator (VDR) developed by Forest M. Bird [2]. This technique combines some advantages of high frequency with others of CV support.
The purpose of this randomised study is to compare the use of CV and HFPV in patients with inhalation injury associated with burn damage. This study represents the first randomised trial using this kind of ventilation in patients with inhalation injury.
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Materials and methods
After this protocol was reviewed and authorised by the Institutional Review Board of our hospital, 35 patients admitted during a 20-month period to the Belgian Army Burn Centre of Brussels were enrolled in the protocol according to the following inclusion criteria: age >18 years, burned surface area >20% and presence of inhalation injury according to recognised criteria (closed space fire, facial burns, carbonaceous sputum, positive bronchial fibroscopy with soot in the airways), with need for
Results
Patients’ characteristics are listed in Table 2. There was no significant difference between the two groups for age and burn surface area. A statistically significant increase of the PaO2/FiO2 ratio was observed in the HFPV group during the first 3 days post-injury (Fig. 1): FiO2 in the CV group was significantly higher than in the HFPV group (Fig. 2), while no statistical significance was noted between the two groups for CO2 elimination (Fig. 3), PaO2 (Fig. 4), ventilatory pressures PIP and
Discussion
Smoke inhalation is frequently associated with burn injury and seems to be the first cause of death on the site of the disaster (30–90% in all populations). Several physio-pathological mechanisms for inhalation injury toxicity have been proposed (toxins, anoxia, airway obstruction, etc.) [16], [17], [24].
Cioffi et al. report a 20–40% increase in mortality in burn patients in presence of inhalation injury [1]. The mechanisms of this phenomenon are complex and not fully understood [1], [6], [22].
Acknowledgements
We gratefully acknowledge the help and support of the intensive care staff.
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