Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure

Arnold, John H.; Hanson, James L.; Toro-Figuero, Luis O.; Gutiérrez, Juan A.; Berens, Richard J.; Anglin, David L.

doi:10.1097/00003246-199422100-00006

Cited by 333 publications

(94 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Yet, in spite of years of largely positive experimental studies, case series and small clinical trials, there were no adequate, large-scale randomised controlled trials (RCTs) to determine whether or not HFOV confers any advantage to patients requiring artificial ventilation for acute hypoxaemic respiratory failure when compared with conventional artificial ventilation. A Cochrane systematic review, also published as a journal paper, 14,15 located only two methodologically sound RCTs in this area, one in children 16 and one in adults. 17 A more recent systematic review of all of the eight clinical trials in children and adults 18 published to date concluded that, in patients with acute lung injury (ALI) or ARDS, HFOV initially improved oxygenation {as measured by the ratio of the arterial oxygen partial pressure to the fractional inspired oxygen concentration [PaO 2 : FiO 2 ratio (P : F ratio); 7 trials, n = 323, ratio of means and 95% confidence interval (CI) 1.24 to 1.10-1.40]} but did not alter the duration of mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Lall

Hamilton

Young

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

BackgroundPatients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage.ObjectivesTo determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation.DesignA parallel, randomised, unblinded clinical trial.SettingUK intensive care units.ParticipantsMechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment.InterventionsTreatment arm HFOV using a Novalung R100®ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning.Control arm Conventional mechanical ventilation using the devices available in the participating centres.Main outcome measuresThe primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained.ResultsOne hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) −6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40;p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to society per QALY of £88,790 and an ICER for the cost to the NHS per QALY of £78,260.ConclusionsThe use of HFOV had no effect on 30-day mortality in adult patients undergoing mechanical ventilation for ARDS and no economic advantage. We suggest that further research into avoiding ventilator-induced lung injury should concentrate on ventilatory strategies other than HFOV.Trial registrationCurrent Controlled Trials ISRCTN10416500.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 23. See the NIHR Journals Library website for further project information.

show abstract

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Lall

Hamilton

Young

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

show abstract

“…This "open airway strategy" is similar to the open lung strategy in diffuse alveolar disease, where MAP is used to recruit alveoli. 2,6,7 The active expiratory phase of the Sensor Medics 3100A oscillator should minimize inadvertent dynamic air-trapping. 5 There might be some concern that the active exhalation causes collapse of the larger airways and further air-trapping.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 In severe asthma, airway resistance is increased due to a narrowed diameter by inflammation, mucus plugging, edema, and bronchospasm. During conventional mechanical ventilation (CMV), high inspiratory pressures are often sufficient to open collapsed and obstructed airways and ventilate the alveoli.…”

Section: Introductionmentioning

confidence: 99%

Status asthmaticus treated by high-frequency oscillatory ventilation

Duval¹,

Vught²

2000

Pediatr. Pulmonol.

View full text Add to dashboard Cite

“…Die HFOV wird seit über 10 Jahren als Rescue in der Beatmung pädiatrischer Patienten mit schweren Lungenerkrankungen eingesetzt [3,26]. Mit der Entwicklung von leistungsfähigeren Geräten entfallen früher geltende Gewichtslimiten, und die HFOV kann zunehmend auch bei Erwachsenen eingesetzt werden [12,27].…”

Section: Indikationenunclassified

Beatmung von Neugeborenen und Säuglingen

Berger

Stocker²

2004

Anaesthesist

View full text Add to dashboard Cite

Anaesthesiologists must be familiar with the particularities of the respiratory physiology of newborns and infants when providing perioperative care to these patients. Even brief periods of inadequate respiratory support can cause atelectatrauma and volutrauma which in turn can have deleterious cardiorespiratory consequences and accentuate pre-existing lung disease. A variety of respirators and respiratory support strategies are available and should be selected to meet a patient's particular needs. Optimal PEEP and normal tidal volumes during conventional ventilation, high volume strategy during high frequency ventilation, and permissive hypercapnia are the corner stones of a lung protective strategy. Using an interdisciplinary approach, surgery in the intensive care unit using total intravenous anaesthesia with the uninterrupted use of the ICU equipment is an attractive option for the most vulnerable patients in this age group.

show abstract

Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure

Cited by 333 publications

References 0 publications

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Status asthmaticus treated by high-frequency oscillatory ventilation

Beatmung von Neugeborenen und Säuglingen

Contact Info

Product

Resources

About