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High frequency percussive ventilation and low FiO(2).

Margaret Starnes-Roubaud¹, Elizabeth A Bales, Alex Williams-Resnick

¹Division of Plastic and Reconstructive Surgery, Department of Surgery and Department of Anesthesiology, Los Angeles County + University of Southern California, Keck School of Medicine, Los Angeles, CA, United States. Margaret.starnes@surgery.usc.edu

Burns : Journal of the International Society for Burn Injuries

|July 7, 2012

Summary

A low fraction of inspired oxygen (FiO(2)) with high-frequency percussive ventilation (HFPV) is a safe and effective strategy for burn patients. This protective approach may reduce lung injury and improve outcomes in critically ill patients.

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Area of Science:

Critical Care Medicine
Pulmonary Medicine
Burn Surgery

Background:

High-frequency percussive ventilation (HFPV) is a rescue therapy for acute lung injury.
High oxygen levels (FiO(2)) can be toxic to the lungs.
Burn patients often require prolonged mechanical ventilation.

Purpose of the Study:

To evaluate a low FiO(2) (0.25) HFPV protocol.
To assess its efficacy as a protective strategy.
To determine outcomes in burn patients on mechanical ventilation >10 days.

Main Methods:

Retrospective, single-center study.
Included burn patients from December 2002 to May 2005.
Collected demographic and physiologic data from admission to outcome.

Main Results:

32 burn patients were analyzed; 1 failed the protocol.
Average age 46, 28% had >40% TBSA burn.
50% developed pneumonia, 28% died; no ARDS or barotrauma.
No association between inhalation injury and mortality.

Conclusions:

Low FiO(2)/HFPV is safe and effective for critically ill burn patients.
Reducing oxidative stress from high FiO(2) may improve outcomes.
This protocol offers a protective ventilation strategy.