@article{3127239,
    title = "The effect of high-frequency oscillatory ventilation combined with tracheal gas insufflation on extravascular lung water in patients with acute respiratory distress syndrome: A randomized, crossover, physiologic study",
    author = "Vrettou, C.S. and Zakynthinos, S.G. and Malachias, S. and Mentzelopoulos, S.D.",
    journal = "Journal of Critical Care",
    year = "2014",
    volume = "29",
    number = "4",
    pages = "568-573",
    publisher = "W.B. Saunders",
    issn = "0883-9441",
    doi = "10.1016/j.jcrc.2014.03.020",
    keywords = "adult;  adult respiratory distress syndrome;  aged;  arterial gas;  article;  artificial ventilation;  blood gas analysis;  blood oxygen tension;  body weight;  central venous blood gas analysis;  clinical article;  controlled study;  crossover procedure;  female;  hemodynamics;  high frequency oscillatory ventilation;  high frequency ventilation;  human;  lung compliance;  lung edema;  lung gas exchange;  lung mechanics;  male;  oxygen therapy;  oxygenation;  prospective study;  randomized controlled trial;  thermodilution;  tracheal gas insufflation;  treatment duration;  aeration;  breathing;  high frequency ventilation;  lung extravascular fluid;  middle aged;  pathophysiology;  physiology;  procedures;  Pulmonary Edema;  Respiratory Distress Syndrome, Adult;  utilization, Adult;  Blood Gas Analysis;  Body Weight;  Cross-Over Studies;  Extravascular Lung Water;  Female;  High-Frequency Ventilation;  Humans;  Insufflation;  Male;  Middle Aged;  Prospective Studies;  Pulmonary Edema;  Respiration;  Respiratory Distress Syndrome, Adult",
    abstract = "Purpose: High-frequency oscillation combined with tracheal gas insufflation (HFO-TGI) improves oxygenation in patients with acute respiratory distress syndrome (ARDS). There are limited physiologic data regarding the effects of HFO-TGI on hemodynamics and pulmonary edema during ARDS. The aim of this study was to investigate the effect of HFO-TGI on extravascular lung water (EVLW). Materials and methods: We conducted a prospective, randomized, crossover study. Consecutive eligible patients with ARDS received sessions of conventional mechanical ventilation with recruitment maneuvers (RMs), followed by HFO-TGI with RMs, or vice versa. Each ventilatory technique was administered for 8 hours. The order of administration was randomly assigned. Arterial/central venous blood gas analysis and measurement of hemodynamic parameters and EVLW were performed at baseline and after each 8-hour period using the single-indicator thermodilution technique. Results: Twelve patients received 32 sessions. Pao2/fraction of inspired oxygen and respiratory system compliance were higher (P < .001 for both), whereas extravascular lung water index to predicted body weight and oxygenation index were lower (P = .021 and .029, respectively) in HFO-TGI compared with conventional mechanical ventilation. There was a significant correlation between Pao2/fraction of inspired oxygen improvement and extravascular lung water index drop during HFO-TGI (Rs = -0.452, P = .009). Conclusions: High-frequency oscillation combined with tracheal gas insufflation improves gas exchange and lung mechanics in ARDS and potentially attenuates EVLW accumulation. © 2014 Elsevier Inc."
}