High-frequency oscillatory ventilation for patients during exudative phase of severe ARDS

High frequency oscillatory ventilation (HFOV) is theoretically ideal for lung protective strategy ventilation (LPSV) in acute respiratory distress syndrome (ARDS). However, recent studies revealed unsatisfactory outcomes. The authors conducted a study to examine this phenomenon in patients with early phase of moderate to severe ARDS.

To evaluate the effectiveness of HFOV in patients with early phase of moderate to severe ARDS. The primary outcome was 30 days all-cause mortality.

The study was a matched-case controlled clinical trial performed in the medical intensive care units, Faculty of Medicine, Siriraj Hospital. The authors compared HFOV with LPSV in adult patients with the early phase of ARDS who received mechanical ventilation less than 72 hours and had moderate to severe hypoxemia (PaO/FiO2 ratio less than or equal 150).

Between June 2010 and February 2014, 49 patients with moderate to severe ARDS were included. Fourteen patients who received HFOV were matched with 16 patients who received LPSV. The 30-day mortality in HFOV group was 61.5%; while in control group, 50% (p = 0.53). The authors found use of higher doses of sedative drugs and muscle relaxants in HFOV group. In addition, this group had high-level of mean airway pressure (mPaw). The presence of hemodynamic instability was not different in both groups.

In adult patients in the early phase of moderate to severe ARDS who received mechanical ventilation for less than 72 hours, HFOV did not decrease the 30-day mortality. Thus, this support should be only a rescue therapy for refractory hypoxemia cases and in highly selected patients.