Benefits and Risks Associated with the R100 High Frequency Oscillatory Ventilator for Patients with Severe Hypoxaemic Respiratory Failure

Abstract

High frequency oscillatory ventilation has been shown to improve oxygenation of patients with severe respiratory failure. This prospective study examined the potential benefits and risks of the latest generation high frequency oscillatory ventilator (R100, Metran, Saitama, Japan), initiated when the target oxygenation could not be achieved by conventional mechanical ventilation in adult patients with severe hypoxaemic respiratory failure. Thirty-six patients with severe respiratory failure treated with the R100 high frequency oscillatory ventilator were considered. Pneumonia and exacerbation of interstitial pneumonia were the main causes of respiratory failure. The median time on conventional mechanical ventilation or airway pressure release ventilation prior to high frequency oscillatory ventilation was 9.3 hours (interquartile range 4.8 to 25). P a O 2 /FiO 2 at 24 hours after initiation of high frequency oscillatory ventilation was significantly better than the P a O 2 /FiO 2 at baseline (151.2±61.2 vs 99.5±50.0, P=0.0001). Refractory hypoxaemia within 24 hours was associated with a high risk of mortality (P=0.0092) and 23 patients (64%), including 11 patients with exacerbation of interstitial pneumonia, died by 30 days. Of the 36 patients included in the study (including one who had developed pneumothorax before high frequency oscillatory ventilation), 12 (33%) developed barotrauma during the course of their intensive care unit stay. In the multivariate analysis, only exacerbation of interstitial pneumonia was a significant risk factor for barotrauma. In summary, the latest generation high frequency oscillatory ventilator could improve oxygenation in adult patients with life-threatening hypoxaemic respiratory failure but the incidence of barotrauma was substantial.

Different ventilation modes combined with ambroxol in the treatment of respiratory distress syndrome in premature infants

“…It is associated with various side effects, including injury to the airways and lung parenchyma due to its invasive nature (9). These side effects led to the invention of modern mechanical ventilation methods including high frequency oscillatory ventilation (HFOV), which can be set to trigger or to coincide with the baby's inspiratory efforts (10,11). Recent studies have confirmed the efficacy of modern ventilators as compared to conventional ventilators (12,13).…”

Right over left ventricular end-diastolic area relevance to predict hemodynamic intolerance of high-frequency oscillatory ventilation in patients with severe ARDS

“…High-frequency oscillatory ventilation (HFOV) is a non-CMV technique that could improve alveolar recruitment and achieve protective ventilation with the most severe cases of ARDS using very low tidal volume (VT) and relatively high mean airway pressure (mPaw) as a surrogate for positive end-expiratory pressure (PEEP). Previous studies have clearly shown an improvement in oxygenation with HFOV [ 2 ] and even suggest a reduction in mortality [ 3 , 4 ] although the level of improvement in oxygenation is unpredictable and HFOV can indeed worsen oxygenation in some patients [ 5 ]. Alveolar recruitment—and thus improvement in gas exchange—seems to depend on the level of mPaw [ 6 , 7 ] and a high mPaw (around 30 cm H 2 O) for a period of several days seems to give the best results [ 6 ].…”

The Physiological Basis of High-Frequency Oscillatory Ventilation and Current Evidence in Adults and Children: A Narrative Review

“…Early case series of HFOV in adults reported improvements in oxygenation with variable effects on hemodynamics ( Fort et al, 1997 ; Claridge et al, 1999 ; Mehta et al, 2001 ). Subsequent studies confirmed these results, but most enrolled less than 50 subjects ( Fort et al, 1997 ; Claridge et al, 1999 ; Mehta et al, 2001 ; Andersen et al, 2002 ; David et al, 2003 ; Mehta et al, 2004 ; Ferguson et al, 2005 ; Finkielman et al, 2006 ; Pachl et al, 2006 ; Fessler et al, 2008 ; Kao et al, 2011 ; Niwa et al, 2011 ; Camporota et al, 2013 ; Jog et al, 2013 ; Naorungroj et al, 2015 ; Thind et al, 2021 ). HFOV has also been described in three small case series of burn patients involving 6 to 30 subjects with mortality between 32 and 83% ( Cartotto et al, 2001 ; Cartotto et al, 2004 ; Cartotto et al, 2009 ).…”