Τίτλος:
Severity of Hypoxemia and Effect of High-Frequency Oscillatory
Ventilation in Acute Respiratory Distress Syndrome
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Rationale: High-frequency oscillatory ventilation (HFOV) is
theoretically beneficial for lung protection, but the results of
clinical trials are inconsistent, with study-level meta-analyses
suggesting no significant effect on mortality.
Objectives: The aim of this individual patient data meta-analysis was to
identify acute respiratory distress syndrome (ARDS) patient subgroups
with differential outcomes from HFOV.
Methods: After a comprehensive search for trials, two reviewers
independently identified randomized trials comparing HFOV with
conventional ventilation for adults with ARDS. Prespecified effect
modifiers were tested using multivariable hierarchical logistic
regression models, adjusting for important prognostic factors and
clustering effects.
Measurements and Main Results: Data from 1,552 patients in four trials
were analyzed, applying uniform definitions for study variables and
outcomes. Patients had a mean baseline Pa-O2/FIO2 of 11 +/- 639 mm Hg;
40% had severe ARDS (Pa-O2/FIO2,100 mm Hg). Mortality at 30 days was
321 of 785 (40.9%) for HFOV patients versus 288 of 767 (37.6%) for
control subjects (adjusted odds ratio, 1.17; 95% confidence interval,
0.94-1.46; P = 0.16). This treatment effect varied, however, depending
on baseline severity of hypoxemia (P = 0.0003), with harm increasing
with Pa-O2/FIO2 among patients with mild-moderate ARDS, and the
possibility of decreased mortality in patients with very severe ARDS.
Compliance and body mass index did not modify the treatment effect. HFOV
increased barotrauma risk compared with conventional ventilation
(adjusted odds ratio, 1.75; 95% confidence interval, 1.04-2.96; P =
0.04).
Conclusions: HFOV increases mortality for most patients with ARDS but
may improve survival among patients with severe hypoxemia on
conventional mechanical ventilation.
Συγγραφείς:
Meade, Maureen O.
Young, Duncan
Hanna, Steven
Zhou, Qi and
Bachman, Thomas E.
Bollen, Casper
Slutsky, Arthur S.
Lamb,
Sarah E.
Adhikari, Neill K. J.
Mentzelopoulos, Spyros D. and
Cook, Deborah J.
Sud, Sachin
Brower, Roy G.
Thompson, B.
Taylor
Shah, Sanjoy
Stenzler, Alex
Guyatt, Gordon and
Ferguson, Niall D.
Περιοδικό:
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Εκδότης:
AMER THORACIC SOC
Λέξεις-κλειδιά:
high-frequency oscillatory ventilation; acute respiratory distress
syndrome; mechanical ventilation
DOI:
10.1164/rccm.201609-1938OC
