@article{3152744,
    title = "Intermittent recruitment with high-frequency oscillation/tracheal gas
insufflation in acute respiratory distress syndrome",
    author = "Mentzelopoulos, S. D. and Malachias, S. and Zintzaras, E. and Kokkoris, and S. and Zakynthinos, E. and Makris, D. and Magira, E. and Markaki, V. and and Roussos, C. and Zakynthinos, S. G.",
    journal = "The European respiratory journal",
    year = "2012",
    volume = "39",
    number = "3",
    pages = "635-647",
    publisher = "EUROPEAN RESPIRATORY SOC JOURNALS LTD",
    doi = "10.1183/09031936.00158810",
    keywords = "Adult; clinical trial; high-frequency ventilation; respiratory distress
syndrome",
    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,O-2)/inspiratory oxygen fraction (FI,O-2) of < 150 mmHg for > 12
consecutive hours at an end-expiratory pressure of >= 8 cmH(2)O.
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,O-2/FI,O-2, oxygenation index, plateau pressure
and respiratory compliance were improved in the HFO-TGI group versus the
CMV group (p < 0.001 for group x time). Within days 1-60, the HFO-TGI
group had more ventilator-free days versus the CMV group (median
(interquartile range) 31.0 (0.0-42.0) versus 0.0 (0.0-23.0) days; p <
0.001), and more days without respiratory, circulatory, renal,
coagulation and liver failure (p <= 0.003). Survival to hospital
discharge was higher in the HFO-TGI group versus 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."
}