Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome
- 1 September 2011
- journal article
- research article
- Published by European Respiratory Society (ERS) in European Respiratory Journal
- Vol. 39 (3), 635-647
- https://doi.org/10.1183/09031936.00158810
Abstract
In acute respiratory distress syndrome (ARDS), recruitment sessions of high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) with short-lasting recruitment manoeuvres (RMs) may improve oxygenation and enable reduction of subsequent conventional mechanical ventilation (CMV) pressures. We determined the effect of adding HFO-TGI sessions to lung-protective CMV on early/severe ARDS outcome. We conducted a prospective clinical trial, subdivided into a first single-centre period and a second two-centre period. We enrolled 125 (first period, n=54) patients with arterial oxygen tension (Pa,O2)/inspiratory oxygen fraction (FI,O2) of 12 consecutive hours at an end-expiratory pressure of ≥8 cmH2O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n=61) or CMV group (receiving lung-protective CMV and RMs; n=64). The primary outcome was survival to hospital discharge. Pre-enrolment ventilation duration was variable. During days 1–10 post-randomisation, Pa,O2/FI,O2, oxygenation index, plateau pressure and respiratory compliance were improved in the HFO-TGI group versus the CMV group (pversus the CMV group (median (interquartile range) 31.0 (0.0–42.0) versus 0.0 (0.0–23.0) days; pversus the CMV group (38 (62.3%) out of 61 versus 23 (35.9%) out of 64 subjects; p=0.004). Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.This publication has 36 references indexed in Scilit:
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