High frequency percussive ventilation and low FiO(2)

Background

High-frequency percussive ventilation (HFPV) is an effective rescue therapy in ventilated patients with acute lung injury. High levels of inspired oxygen (FiO₂) are toxic to the lungs. The objective of this study was to review a low FiO₂ (0.25)/HFPV protocol as a protective strategy in burn patients receiving mechanical ventilation greater than 10 days.

Methods

A single-center, retrospective study in burn patients between December 2002 and May 2005 at the LAC + USC Burn Center. Demographic and physiologic data were recorded from time of admission to extubation, 4 weeks, or death.

Results

32 subjects were included in this study, 1 patient failed the protocol. 23 of 32 (72%) patients were men and mean age was 46 ± 15 years. Average TBSA burn was 30 ± 20 with 9 of 32 (28%) having >40% TBSA involved. Average burn index was 76 ± 21. 22 of 32 (69%) had inhalation injury and 23 of 32 (72%) had significant comorbidities. Average ventilator parameters included ventilator days 24 ± 12, FiO₂ 0.28 ± 0.03, PaO₂ 107 ± 15 Torr, PaCO₂ 42 ± 4 Torr, and PaO₂/FiO₂ ratio 395 ± 69. 16 of 32 (50%) patients developed pneumonia and 9 of 32 (28%) died. No patient developed ARDS, barotrauma, or died from respiratory failure. There was no association between inhalation injury and mortality in this group of patients.

Conclusion

A low FiO₂/HFPV protocol is a safe and effective way to ventilate critically ill burn patients. Reducing the oxidative stress of high inspired oxygen levels may improve outcome.     

High frequency percussive ventilation and conventional ventilation after smoke inhalation: a randomised study

Inhalation injury and bacterial pneumonia represent some of the most important causes of mortality in burn patients. Thirty-five severely burned patients were randomised on admission for conventional ventilation (CV; control group) versus high frequency percussive ventilation (HFPV; study group). HFPV is a ventilatory mode, introduced 10 years ago which combines the advantages of CV with some of those of high frequency ventilation.Arterial blood gases, ventilatory and hemodynamic variables were recorded for 5 days at 2h intervals. Incident complications were classically managed. A statistical analysis (Student's t-test and Wilcoxon signed rank test) demonstrated a significant higher PaO(2)/FiO(2) from days 0 to 3 in the HFPV group. No significant differences were observed for the other parameters. Our findings suggest that HFPV can improve blood oxygenation during the acute phase following inhalation injury allowing reduction of FiO(2). No significant differences were observed between groups for mortality nor incidence of infectious complications in this study.     

High frequency percussive ventilation in burn patients: hemodynamics and gas exchange

High frequency percussive ventilation (HFPV) is a recent ventilatory mode, which combines conventional cycles with high frequency percussions. HFPV was initially instituted as salvage therapy after acute respiratory failure following smoke inhalation injury achieving in each case a dramatic improvement of blood oxygenation, PaCO(2) and ventilatory pressures. This study investigates the influence of HFPV on hesmodynamics, blood oxygenation and ventilatory parameters in eight stable ICU burn patients requiring artificial ventilatory support during a postoperative period following traumatic injury. Periods of 2h were analysed receiving conventional ventilation and HFPV with a high frequency of 400 and 800 cycles/min. Hemodynamic data were not significantly modified; peak inspiratory pressure was significantly lower under HFPV but mean airway pressure was unchanged. Blood oxygenation and CO(2) elimination were significantly improved under HFPV. No side effects were noted. These observations suggest that HFPV could improve pulmonary gas exchanges under lower peak pressures and without hemodynamic compromise. HFPV could represent an interesting alternative open lung strategy method to improve alveolar recruitment.     

High frequency ventilation

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - The potential role of HFV has yet to be fully defined. Its use should be approached with caution, ensuring that the possible...     

High frequency ventilation

High frequency ventilation (HFV) is a general term that refers to a family of mechanical ventilation techniques that involves ventilator rates that are supraphysiological (more than 60 breaths/minute), and utilizes tidal volumes that are equal or less than the anatomical dead space of the airways. This paper is a review of the different HFV techniques, along with the mechanisms of oxygenation and ventilation, the clinical applications, and management strategies for different disease entities, and possible complications of HFV.     

High frequency jet ventilation

A case is described where high frequency jet ventilation was used to avoid the cardiovascular depressant effects associated with conventional ventilation. Early weaning from inotropic and ventilatory support proved possible.     

High frequency jet ventilation

High frequency jet ventilation for thoracic surgery offers some practical advantages over intermittent pressure ventilation using bronchial tubes. Satisfactory blood gases were obtained in 50 patients and good operating conditions were provided.     

High frequency ventilation: current status

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -