High-frequency oscillation ventilation for hypercapnic failure of conventional ventilation in pulmonary acute respiratory distress syndrome

Abstract

IntroductionHigh-frequency oscillation ventilation (HFOV) is regarded as particularly lung protective. Recently, HFOV has been shown to be not beneficial for acute respiratory distress syndrome (ARDS) patients in general. Due to its special physical effects, it could be beneficial, however, in inhomogeneous ARDS. This study evaluates the effect of HFOV on PaCO2 removal in hypercapnic patients with ARDS of pulmonary origin.MethodsBetween October 2010 and June 2014 patients with ARDS of pulmonary origin with PaO2/FiO2 ratio >60 mmHg, but respiratory acidosis (pH <7.26) under optimized protective ventilation were switched to HFOV, using moderate airway pressure (adopting the mean airway pressure of the prior ventilation). Data from these patients were analyzed retrospectively; PaCO2 and pH before, 1 h and 24 h after the start of HFOV were compared.ResultsTwenty-six patients with PaO2/FiO2 ratio 139 ± 49 and respiratory acidosis (PaCO2 68 ± 12 mmHg) were put on HFOV after 17 ± 22 h of conventional ventilation. Mean airway pressure was 19 cm H2O (15 to 28). PaCO2 decreased significantly: after 1 hour the mean difference was −14 ± 10 mmHg; P <0.01 and after 24 hours −17 ± 12 mmHg; P <0.01; n = 24. CO2 clearance improved in all but two patients; in those, extracorporeal lung support was initiated. Oxygenation remained unchanged after 1 h and slightly increased after 24 h. No complications related to HFOV were observed. Twenty-two patients improved and could be weaned from HFOV. Twenty patients (77%) were alive on day 30.ConclusionsHFOV could be a useful alternative in patients with ARDS of pulmonary origin with hypercapnic failure of lung-protective conventional ventilation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0935-4) contains supplementary material, which is available to authorized users.

High-frequency oscillatory ventilation is an effective treatment for severe pediatric acute respiratory distress syndrome with refractory hypoxemia

“… 6 Although Derdak et al showed that HFOV slightly increased PaCO 2 in adults, 15 a recent study demonstrated that HFOV reduced PaCO 2 efficiently in ARDS of pulmonary origin with hypercapnic failure of CMV. 16 Hence, the unremarkable effect on CO 2 removal in our study may be due to the heterogeneous etiology and small sample population.…”

Effective Tidal Volume for Normocapnia in Very-Low-Birth-Weight Infants Using High-Frequency Oscillatory Ventilation

“…HFOV is effective for ventilation control compared to conventional mechanical ventilation. 21 Targeting the ideal DCO 2 may induce a more stable PCO 2 level, which has the potential to reduce both hypercarbia and hypocarbia. However, the DCO 2 has various values depending on the size of the lung and underlying conditions, and the absolute target value has not yet been confirmed.…”

Management of hypercapnia in critically ill mechanically ventilated patients—A narrative review of literature

“…34 Friesecke et al reported the use of HFOV in patients with hypercapnic acidosis not responsive to conventional ventilation. 35 In their cohort of 26 patients, 24 patients responded to HFOV with improvement in hypercapnia and acidosis at 24 h of initiating HFOV. It is, however, important to note that the routine use of HFOV was not recommended due to lack of mortality benefit and a potential for harm with the use of HFOV as compared to conventional ventilation with low tidal volumes.…”