Document Detail

Comparison of high-frequency oscillation and tracheal gas insufflation versus standard high-frequency oscillation at two levels of tracheal pressure.
MedLine Citation:
PMID:  20232047     Owner:  NLM     Status:  MEDLINE    
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 (P(tr)). We compared standard HFO and HFO-TGI matched for P(tr), in order to determine whether TGI affects gas exchange independently from P (tr). 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 (P(aw)) was titrated to a P(tr) that was either equal to (low P(aw)) or 3 cmH(2)O higher than (high P(aw)) the P(tr) of the preceding conventional mechanical ventilation. On day 2, the protocol was repeated at the alternative P(tr) level relative to day 1. RESULTS: Gas exchange and hemodynamics were determined before, during, and after HFO/HFO-TGI sessions. HFO-TGI-high P(aw) versus HFO-high P(aw) resulted in significantly higher PaO(2)/inspired O(2) fraction (FiO(2)) [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 P(aw), versus HFO-low P(aw), resulted in significantly higher PaO(2)/FiO(2) (222.8 +/- 14.6 versus 141.3 +/- 8.7 mmHg; mean increase: 58%; P < 0.001). PaCO(2) was significantly lower during HFO-TGI-high P(aw) versus HFO-high P(aw) (45.3 +/- 1.6 versus 53.7 +/- 1.9 mmHg; mean decrease: 16%; P = 0.037). CONCLUSIONS: At the same P(tr) level, HFO-TGI results in superior gas exchange compared with HFO.
Spyros D Mentzelopoulos; Sotiris Malachias; Stelios Kokkoris; Charis Roussos; Spyros G Zakynthinos
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-03-16
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-07     Completed Date:  2010-07-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  810-6     Citation Subset:  IM    
First Department of Intensive Care Medicine, University of Athens Medical School, Athens, Greece.
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MeSH Terms
Blood Gas Analysis
Cross-Over Studies
High-Frequency Ventilation / methods*
Insufflation / methods*
Intensive Care Units
Middle Aged
Prospective Studies
Pulmonary Gas Exchange
Respiratory Distress Syndrome, Adult / therapy*

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