Τίτλος:
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
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Vrettou, C.S.
Zakynthinos, S.G.
Malachias, S.
Mentzelopoulos, S.D.
Περιοδικό:
Journal of Critical Care
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.jcrc.2014.03.020
