High-Frequency Oscillatory Ventilators in Burn Patients

Abstract

The objective of the study is to review a single institution's experience with high-frequency oscillatory ventilation (HFOV) and compare patient characteristics, outcomes, and complications with other reported studies of HFOV use in burn patients with acute respiratory distress syndrome and respiratory failure. This study is a retrospective chart review of the burn patients treated with HFOV in Pediatric Burn Unit at Riley Hospital for Children from October 1996 to April 2007. Patient data were collected, including demographics, percentage of TBSA burn, percentage of full-thickness burn, mechanisms of burn, settings on conventional mechanical ventilation and HFOV, and blood gas data before initiation of HFOV and at 1, 3, 6, 12, 24, 72 (3 days), 120 (5 days), 168 (7 days), 240 (10 days), and 336 hours (14 days). Length of stay, mortality, and complications were also included. HFOV was used 24 times in 21 patients between October 1996 and April 2007 with a mean age of 10 ± 11 years. At initiation of HFOV, the PaO2/FiO2 and oxygenation index values were 109 ± 26 and 36 ± 12, respectively. At stop, the PaO2/FiO2 improved to 166 ± 24 with an average increase from before HFOV of 57 ± 39 (P < .002). At 5 days of HFOV, oxygenation index improved to 14.1 ± 1.7 (P < .02) but did not significantly improve at discontinuation of HFOV at 28.8 ± 6.2 (P = .11). The mortality rate during admission to the burn unit was 29%. Barotrauma occurred in 38% of patients during HFOV. Severe hypercapnea was present briefly in 49% of patients, and this was refractory to standard treatment in 19%. In our experience, HFOV in severe burn patients has significant, early, and sustained improvement in oxygenation. Earlier institution of HFOV seems to significantly lower rates of barotraumas.

Mechanical Ventilation Strategies in the Critically Ill Burn Patient: A Practical Review for Clinicians

“…High-frequency oscillatory ventilation (HFOV) is a mode of MV which shares some features with HFPV [24]. Although HFOV is no longer recommended for the treatment of ARDS in adults [25,26] or children [27], it has been used for children with burns and/or inhalation injuries [28][29][30]. Most literature regarding the use of HFOV in this population has been limited to small, single-center, retrospective studies [28].…”

Diagnosis and Management of Inhalation Injuries in U. S. Children

“…Существует много литературы с доводами против использования HFOV (высокочастотная осцилляторная вентиляция) [27,30]. К недостаткам HFOV относятся технические сложности аспирации секрета, наличие большого количества способов увеличения объема легких, скопление газов, бронхоспазм и стимуляция образования экссудата и агрегатов [30,31]. Другие отрицательные моменты использования HFOV у детей с ингаляционными травмами связаны с трудностями в проведении ингаляционной (аэрозольной) терапии и с высокой вероятностью возникновения баротравмы [31].…”

High-Frequency Ventilation Modalities as Salvage Therapy for Smoke Inhalation–Associated Acute Lung Injury: A Systematic Review

“…80 Alveolar ventilation is enhanced by increasing the power and decreasing the frequency of oscillation. 80 Initial reports of the usefulness of HFOV appeared promising, 39,81 but with more clinical experience, it became apparent that HFOV had many limitations and few advantages when used as a rescue therapy in the setting of smoke inhalation injury. When used for SI-ALI, it has been reported that improvements in oxygenation are attenuated, 80,82 the risk of severe hypercapnia may be increased, 82 and adjunctive therapy including bronchodilators, inhaled heparin, and N-acetyl cysteine may not be instituted.…”

“…The available lower quality evidence that was not included, however, does not support the efficacy of HFOV to treat patients with SI-ALI and suggests that it may be detrimental in this population. 39,80,82 It is unclear whether the failure of patients to improve in these studies is a direct consequence of the ventilation mode or because it precludes the aggressive pulmonary "toilette" and nebulization therapies that have been reported to improve outcomes in patients with SI-ALI. 16,18,50 High-frequency percussive ventilation.…”

“…37 On the other hand, HFV techniques have been used to manage patients with SI-ALI for decades, but their use has varied significantly by practitioner as well as center and their effects on clinical outcomes have been challenging to gauge. [38][39][40][41][42][43][44][45][46][47] Therefore, our goal was to conduct a systematic review of HVF techniques in SI-ALI and to discuss the merits and limitations of these modalities.…”