Acute effects of combined high-frequency oscillation and tracheal gas insufflation in severe acute respiratory distress syndrome*

Mentzelopoulos, Spyros D.; Roussos, Charis; Koutsoukou, Antonia; Sourlas, Sotiris; Malachias, Sotirios; Lachana, Alexandra; Zakynthinos, Spyros

doi:10.1097/01.ccm.0000265738.80832.be

Cited by 42 publications

(52 citation statements)

References 37 publications

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“…1) CMV group: three measurements per day, starting at 09:00 h. 2) HFO-TGI group: just before, during and 6 h after HFO-TGI, and as in CMV group if no longer requiring HFO-TGI. Measurements included arterial/centralvenous blood-gas analysis, haemodynamics and respiratory mechanics while on CMV [7,12]. For between-group comparisons, we used CMV data obtained between 09:00 and 10:00 h in both groups.…”

Section: Follow-upmentioning

confidence: 99%

“…o6 h) and repetitive (according to pre-specified criteria) recruitment sessions of HFO-TGI with RMs could result in a progressively sustained oxygenation improvement, with minimal concurrent risk of long-term HFO-TGI-related adverse effects [2,7,10]. This should enable rapid reduction of subsequent CMV pressures to noninjurious levels [11].…”

mentioning

confidence: 99%

“…When combined with 40-s recruitment manoeuvres (RMs), HFO improves oxygenation versus lung-protective CMV, probably through lung recruitment [6][7][8]. The short-term addition of tracheal gas insufflation (TGI) to HFO may further improve oxygenation versus HFO without TGI and lung-protective CMV [7,8].…”

mentioning

confidence: 99%

“…The short-term addition of tracheal gas insufflation (TGI) to HFO may further improve oxygenation versus HFO without TGI and lung-protective CMV [7,8]. TGI may promote lung recruitment by exerting a positive end-expiratory pressure (PEEP) effect and augmenting HFOdependent distal gas mixing [7][8][9][10].…”

mentioning

confidence: 99%

“…Pressure, volume and respiratory rate values were those displayed by the ventilator. Respiratory compliance was calculated as tidal volume divided by the end-inspiratory to end-expiratory plateau airway pressure difference [7,12]. For both groups, analysed data corresponded to 11 consecutive time-points, i.e.…”

mentioning

confidence: 99%

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Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

Mentzelopoulos¹,

Malachias²,

Ζιντζαράς³

et al. 2011

Eur Respir J

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In acute respiratory distress syndrome (ARDS), recruitment sessions of highfrequency 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, n554) 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 o8 cmH 2 O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n561) or CMV group (receiving lung-protective CMV and RMs; n564). 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 group6time). 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 (pf0.003). 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; p50.004).Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.

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Section: Follow-upmentioning

confidence: 99%

mentioning

confidence: 99%