TY - JOUR
TI - Intermittent recruitment with high-frequency oscillation/tracheal gas
insufflation in acute respiratory distress syndrome
AU - Mentzelopoulos, S. D.
AU - Malachias, S.
AU - Zintzaras, E.
AU - Kokkoris,
AU - S.
AU - Zakynthinos, E.
AU - Makris, D.
AU - Magira, E.
AU - Markaki, V. and
AU - Roussos, C.
AU - Zakynthinos, S. G.
JO - The European respiratory journal
PY - 2012
VL - 39
TODO - 3
SP - 635-647
PB - EUROPEAN RESPIRATORY SOC JOURNALS LTD
SN - null
TODO - 10.1183/09031936.00158810
TODO - Adult; clinical trial; high-frequency ventilation; respiratory distress
syndrome
TODO - 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.
ER -