Clinical surgery–American
High-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review

Presented at the 57th Annual Meeting of the Southwestern Surgical Congress, San Antonio, TX, April 10–12, 2005
https://doi.org/10.1016/j.amjsurg.2006.01.021Get rights and content

Abstract

Background

High-frequency percussive ventilation (HFPV), a hybrid of conventional mechanical ventilation and high-frequency oscillatory ventilation, has been used to salvage patients with persistent hypoxemia on conventional mechanical ventilation. We hypothesized that oxygenation would improve in injured patients with severe hypoxemia who were converted to HFPV after initial management with conventional ventilation.

Methods

Chart review identified patients with acute respiratory distress syndrome (ARDS) managed with HFPV. Oxygenation parameters (oxygenation index, OI; Pao2/Fio2 ratio, P/F) and mean airway pressures (mPaw) were recorded at baseline and at 1 to 4, 8 to 12, and 12 to 24 hours after initiation of HFPV. Values at baseline and each time point after conversion to HFPV were compared by using analysis of variance or Kruskal-Wallis tests.

Results

Twelve patients, over 24 months, were reviewed. Baseline measurements were OI: 42.2 ± 33, P/F: 70 ± 31, (median ± interquartile range), and mPaw: 29 ± 8 (mean ± standard deviation) cm H2O. After initiation of HFPV, mPaw did not differ from baseline. There was an improvement in OI (P = .01) from baseline at 12 to 24 hours after initiation of HFPV and in P/F at 12 to 24 hours (P = .002) and 8 to 12 hours (P = .001) after initiation of HFPV.

Conclusions

HFPV may improve oxygenation in patients with ARDS without a concomitant increase in mPaw. A randomized trial of HFPV versus conventional ventilation in trauma patients is needed.

Section snippets

Materials and Methods

Parkland Memorial Hospital is associated with the University of Texas Southwestern Medical Center and serves as a level I trauma center for the city of Dallas. A retrospective review of our trauma registry for the period of January 2002 through December 2004 was performed to identify patients with ARDS managed with HFPV as an alternative mode of ventilation in severely hypoxic patients initially managed with conventional ventilation techniques. This study was approved by the Institutional

Results

Over the 24-month study period, 15 patients met inclusion criteria and their medical records were reviewed. Three patients with fewer than 3 respiratory data-collection points in 24 hours were excluded. All patients were cared for in the surgical intensive care unit. Mean length of intensive care unit stay was 26 days (range, 2 to 56 days). All surviving patients were transitioned back to conventional mechanical ventilation when oxygenation parameters improved. The mean age was 34 years. The

Comments

This study found that the use of HFPV in patients with ARDS after injury resulted in improved oxygenation parameters (OI and P/F) within the first 12 to 24 hours after conversion from conventional mechanical ventilation techniques. In addition, improvements in oxygenation were not secondary to an increase in mPaw.

Several prior studies have examined the effects of HFPV on patients with ARDS. These studies commonly focused on a heterogeneous population of medical and postoperative surgical

References (16)

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