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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)

Published on: April 7, 2021

Acute Respiratory Distress Syndrome: Mechanical Ventilation vs. High-Frequency Percussive Ventilation

Daniel Sagan^1,2, Carol Parise³, Imran Mohammed^2,4

¹Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, California, USA, lluh.org.

Canadian Respiratory Journal

|July 28, 2026

Abstract

Background:

Studies that investigate the use of high-frequency percussive ventilation (HFPV) are scarce and outdated. HFPV is being used in some facilities primarily as a salvage modality on patients with acute respiratory distress syndrome (ARDS) when a conventional mechanical ventilator has failed to improve outcomes. There still are arguments whether HFPV is an effective ventilation strategy for adult patients with ARDS.

Objectives:

The purpose of this study was to analyze and compare pulmonary gas exchange, as measured by arterial blood gas (ABG) values, between patients with ARDS who were transitioned from conventional mechanical ventilation to HFPV and those who remained on conventional mechanical ventilation.

Methods:

This was a retrospective study between 2016 and 2022. Data was extracted and analyzed from electronic medical records (EMRs) of ARDS patients. ABG results were analyzed from 12 to 2 h before, and 30 min, 2, 12, and 24 h after the initiation of conventional and HFPV. Continuous mandatory ventilation (CMV) settings were compared over 12 and 2 h before the initiation of HFPV and 2, 12, and 24 h after.

Measurements And Main Results:

A total of N = 351 cases were evaluated for this study (n1 = 194 in the CMV group and n2 = 157 in the HFPV group). Patients in the HFPV group had a lower mean baseline pH (7.25 vs. 7.34, p = <0.001) and higher PaCO₂ (56.7 vs. 40.3 mmHg, p = <0.001) when compared to the CMV group. pH has increased and PaCO₂ decreased quickly once HFPV was initiated. The mean baseline PaO₂ was comparative (61.7 vs. 67.4 mmHg, p = 0.21) but the HFPV group had a more rapid and higher improvement compared to the CMV group (121.5 vs. 86.6, p = <0.001). Similarly, there was a significant improvement in the PF ratio after 12 h on HFPV (160.7 vs. 139.7, p = 0.03).

Conclusions:

Results show that HFPV can effectively be used for adult ARDS as a salvage modality when a patient's ABG has become refractory to conventional mechanical ventilation.

Keywords:

ARDS high-frequency percussive ventilation mechanical ventilation

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