Log in | Register

Comparison of high-frequency oscillation and tracheal gas insufflation versus standard high-frequency oscillation at two levels of tracheal pressure

Spyros D. Mentzelopoulos| Sotiris Malachias| Stelios Kokkoris| Charis Roussos| Spyros G. Zakynthinos
Original
Volume 36, Issue 5 / May , 2010

Pages 810 - 816

Abstract

Purpose

In acute respiratory distress syndrome (ARDS), combined high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) may improve oxygenation through a TGI-induced increase in mean tracheal pressure (Ptr). We compared standard HFO and HFO-TGI matched for Ptr, in order to determine whether TGI affects gas exchange independently from Ptr.

Methods

We conducted a prospective, randomized, crossover, physiological study in a 37-bed intensive care unit. Twenty-two patients with early acute lung injury (ALI) or ARDS were enrolled. On day 1, patients were ventilated with HFO, without (60 min) and combined with TGI (60 min) in random order. HFO/HFO-TGI sessions were repeated in inverse order within 7 h. HFO/HFO-TGI mean airway pressure (Paw) was titrated to a Ptr that was either equal to (low Paw) or 3 cmH2O higher than (high Paw) the Ptr of the preceding conventional mechanical ventilation. On day 2, the protocol was repeated at the alternative Ptr level relative to day 1.

Results

Gas exchange and hemodynamics were determined before, during, and after HFO/HFO-TGI sessions. HFO-TGI-high Paw versus HFO-high Paw resulted in significantly higher PaO2/inspired O2 fraction (FiO2) [mean ± standard error of the mean (SEM): 281.6 ± 15.1 versus 199.0 ± 15.0 mmHg; mean increase: 42%; P < 0.001]. HFO-TGI-low Paw, versus HFO-low Paw, resulted in significantly higher PaO2/FiO2 (222.8 ± 14.6 versus 141.3 ± 8.7 mmHg; mean increase: 58%; P < 0.001). PaCO2 was significantly lower during HFO-TGI-high Paw versus HFO-high Paw (45.3 ± 1.6 versus 53.7 ± 1.9 mmHg; mean decrease: 16%; P = 0.037).

Conclusions

At the same Ptr level, HFO-TGI results in superior gas exchange compared with HFO.

Keywords

References

  1. Mentzelopoulos SD, Roussos C, Koutsoukou A, Sourlas S, Malachias S, Lachana A, Zakynthinos SG (2007) Acute effects of combined high-frequency oscillation and tracheal gas insufflation in severe acute respiratory distress syndrome. Crit Care Med 35:1500–1508
    • View reference on publisher's website
    • View reference on PubMed
  2. Dolan S, Derdak S, Solomon D, Farmer C, Johanningman J, Gelineau J, Smith RB (1996) Tracheal gas insufflation combined with high-frequency oscillatory ventilation. Crit Care Med 24:456–465
    • View reference on publisher's website
  3. Nahum A (1998) Equipment review: tracheal gas insufflation. Crit Care 2:43–47
    • View reference on publisher's website
    • View reference on PubMed
  4. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R, the Consensus Committee (1994) The American–European consensus conference on ARDS. Definition, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824
    • View reference on PubMed
  5. Ferguson ND, Chiche JD, Kacmarek RM, Hallett DC, Mehta S, Findlay GP, Granton JT, Slutsky AS, Stewart TE (2005) Combining high-frequency oscillatory ventilation and recruitment in adults with early acute respiratory distress syndrome: the Treatment with Oscillation and an Open Lung Strategy (TOOLS) Trial pilot study. Crit Care Med 33:479–486
    • View reference on publisher's website
    • View reference on PubMed
  6. Gavriely N, Solway J, Drazen JM, Slutsky AS, Brown R, Loring SH, Ingram RH Jr (1985) Radiographic visualization of airway wall movement during oscillatory flow in dogs. J Appl Physiol 58:645–652
    • View reference on PubMed
  7. Solway J, Rossing TH, Saari AF, Drazen JM (1986) Expiratory flow limitation and dynamic pulmonary hyperinflation during high-frequency ventilation. J Appl Physiol 60:2071–2078
    • View reference on PubMed
  8. Gaver DP 3rd, Samsel RW, Solway J (1990) Effects of surface tension and viscosity on airway reopening. J Appl Physiol 69:74–85
    • View reference on PubMed
  9. Yamada Y, Burnham C, Hales CA, Venegas JG (1989) Regional mapping of gas transport during high-frequency and conventional ventilation. J Appl Physiol 66:1209–1218
    • View reference on publisher's website
    • View reference on PubMed
  10. Easley RB, Lancaster CT, Fuld MK, Custer JW, Hager DN, Kaczka DW, Simon BA (2009) Total and regional lung volume changes during high-frequency oscillatory ventilation (HFOV) of the normal lung. Respir Physiol Neurobiol 165:54–60
    • View reference on publisher's website
    • View reference on PubMed
  11. Allen JL, Frantz ID 3rd, Fredberg JL (1985) Regional alveolar pressure during periodic flow. Dual manifestations of gas inertia. J Clin Invest 76:620–629
    • View reference on publisher's website
    • View reference on PubMed
  12. Slutsky AS, Berdine GG, Drazen JM (1980) Steady flow in a model of human central airways. J Appl Physiol 49:417–423
    • View reference on PubMed
  13. Rehder K, Didier EP (1984) Gas transport and pulmonary perfusion during high frequency ventilation in humans. J Appl Physiol 57:1231–1237
    • View reference on PubMed
  14. Hager DN, Fessler HE, Kaczka DW, Shanholtz CB, Fuld MK, Simon BA, Brower RG (2007) Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 35:1522–1529
    • View reference on publisher's website
    • View reference on PubMed
  15. Khoo MC, Slutsky AS, Drazen JM, Solway J, Gavriely N, Kamm RD (1984) Gas mixing during high-frequency ventilation: an improved model. J Appl Physiol 57:493–506
    • View reference on PubMed
  16. Scherer PW, Haselton FR (1982) Convective exchange in oscillatory flow through bronchial-tree models. J Appl Physiol 53:1023–1033
    • View reference on publisher's website
    • View reference on PubMed
  17. Pillow JJ (2005) High-frequency oscillatory ventilation: Mechanisms of gas exchange and lung mechanics. Crit Care Med 33(Suppl):S135–S141
    • View reference on publisher's website
    • View reference on PubMed
  18. Malachias S, Kokkoris S, Zakynthinos S, Mentzelopoulos SD (2009) High frequency oscillation and tracheal gas insufflation for severe acute respiratory distress syndrome: results from a single-center, phase II, randomized controlled trial [NCT00416260] [abstract]. Intensive Care Med 35(Suppl 1):S6
  19. Richecoeur J, Lu Q, Vieira SRR, Puybasset L, Kalfon P, Coriat P, Rouby JJ (1999) Expiratory washout versus optimization of mechanical ventilation during permissive hypercapnia in patients with severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:77–85
    • View reference on PubMed
  20. Martinez-Pérez M, Bernabé F, Peña R, Fernández R, Nahum A, Blanch L (2004) Effects of expiratory tracheal gas insufflation in patients with severe head trauma and acute lung injury. Intensive Care Med 30:2021–2027

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement