High frequency oscillatory ventilation for surgical patients with acute respiratory distress syndrome

BACKGROUND: Numerous studies have suggested that high-frequency oscillatory ventilation (HFOV) used as rescue therapy may improve oxygenation in acute respiratory distress syndrome (ARDS) patients. The purpose of this study is to analyze the efficacy and safety of HFOV in surgical patients with ARDS. METHODS: A total of 16 surgical ARDS patients with severe oxygenation failure received HFOV, despite aggressive conventional mechanical ventilatory support. Mean airway pressure was initially set 3 to 5 cm H2O higher than that for conventional ventilation and was subsequently adjusted to maintain oxygen saturation ≤90% and FiO2 ≤0.6. Oxygenation, ventilation, and hemodynamic parameters were measured during conventional ventilation before initiating HFOV and during HFOV support for a total of 40 hours. Other outcome measures included duration of HFOV, successful weaning rate, cause of failure, complications, survival rate, and cause of death. RESULTS: There was a considerable increase in Pao2/FiO2 ratio after 30 minutes, and this increase was maintained after 12 hours of HFOV throughout the study. There was a significant decrease in oxygenation index after 24 hours of HFOV support. There was no significant change in blood pressure associated with initiation and administration of HFOV. The successful weaning rate from HFOV to conventional ventilation was 75%. The intensive care unit survival rate was 43.8% and hospital survival rate was 37.5%. CONCLUSION: High-frequency oscillatory ventilation was effective and safe in correcting oxygenation failure associated with ARDS in surgical patients. Future research is warranted to identify the suitable patients, timing, and optimal strategy for applying HFOV.