Document Detail


High-frequency percussive ventilation improves perioperatively clinical evolution in pulmonary resection.
MedLine Citation:
PMID:  19325478     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: During thoracotomy, positive end-expiratory pressure is applied to the dependent lung and continuous positive airway pressure (CPAP) inflates the nondependent lung to avoid hypoxemia. These methods do not allow the removal of produced secretions. We hypothesized that high-frequency percussive ventilation(HFPV) can improve both conditions and reduce hospital length of stay in these patients. DESIGN: Randomized prospective study. SETTING: University Hospital. PATIENTS: Fifty-three consecutive patients undergoing elective pulmonary partial resection were enrolled. Nine were excluded because of surgical reasons. INTERVENTIONS: The nondependent lung was ventilated with HFPV in 22 patients and other 22 received CPAP. In both groups,the dependent lung was ventilated with continuous mechanical ventilation. MEASUREMENT AND MAIN RESULTS: Cardiocirculatory variables and blood gas analysis were measured during surgery. Postoperatively,all patients underwent chest physiotherapy, and SpO2,body temperature, the amount of sputum produced, and chest radiography were recorded. Before nondependent lung re-expansion,HFPV patients presented higher PaO2 than CPAP group (p = 0.020). The amount of secretions was higher in chronic obstructive pulmonary disease patients treated with HFPV than in those who received CPAP (199 and 64 mL, respectively, p = 0.028). HFPV increased by 5.28 times the chance of sputum production by chronic obstructive pulmonary disease patients (chi(2) = 46.66, p < 0.0001; odds ratio = 5.28). A patient treated with HFPV had a 3.14-fold larger chance of being discharged earlier than a CPAP-treated subject (likelihood ratio = 11.5, p = 0.0007). CONCLUSIONS: Under the present settings, HFPV improved oxygenation in one-lung ventilation during pulmonary resection. Postoperatively, it decreased the length of stay and increased the removal of secretions in comparison with CPAP.
Authors:
Umberto Lucangelo; Vittorio Antonaglia; Walter A Zin; Marco Confalonieri; Massimo Borelli; Mario Columban; Silvio Cassio; Irene Batticci; Massimo Ferluga; Maurizio Cortale; Giorgio Berlot
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  37     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-22     Completed Date:  2009-05-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1663-9     Citation Subset:  AIM; IM    
Affiliation:
Departments of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, University School of Medicine, Trieste, Italy. u.lucangelo@fmc.units.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Gas Analysis
Chi-Square Distribution
Female
Follow-Up Studies
High-Frequency Ventilation / methods*
Humans
Length of Stay
Male
Middle Aged
Odds Ratio
Perioperative Care / methods*
Pneumonectomy / adverse effects,  methods*
Pneumonia / prevention & control
Positive-Pressure Respiration / methods*
Postoperative Complications / prevention & control*
Probability
Prospective Studies
Pulmonary Gas Exchange
Respiratory Function Tests
Respiratory Therapy
Risk Assessment
Surgical Procedures, Elective
Treatment Outcome
Comments/Corrections
Comment In:
Crit Care Med. 2009 May;37(5):1810-1   [PMID:  19373055 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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