RT Journal Article
SR Electronic
T1 Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 635
OP 647
DO 10.1183/09031936.00158810
VO 39
IS 3
A1 S.D. Mentzelopoulos
A1 S. Malachias
A1 E. Zintzaras
A1 S. Kokkoris
A1 E. Zakynthinos
A1 D. Makris
A1 E. Magira
A1 V. Markaki
A1 C. Roussos
A1 S.G. Zakynthinos
YR 2012
UL http://erj.ersjournals.com/content/39/3/635.abstract
AB In acute respiratory distress syndrome (ARDS), recruitment sessions of high-frequency 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, n=54) patients with arterial oxygen tension (Pa,O2)/inspiratory oxygen fraction (FI,O2) of <150 mmHg for >12 consecutive hours at an end-expiratory pressure of ≥8 cmH2O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n=61) or CMV group (receiving lung-protective CMV and RMs; n=64). The primary outcome was survival to hospital discharge. Pre-enrolment ventilation duration was variable. During days 1–10 post-randomisation, Pa,O2/FI,O2, oxygenation index, plateau pressure and respiratory compliance were improved in the HFO-TGI group versus the CMV group (p<0.001 for group×time). 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 (p≤0.003). 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; p=0.004). Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.