High-frequency oscillatory ventilation with and without arteriovenous extracorporeal lung assist in patients with severe respiratory failure

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• 作者：Markus Kredel ; MD^a ; ^{kredel_m@klinik.uni-wuerzburg.de} ; Joerg Brederlau ; MD^b ; Christian Wunder ; MD^a ; Thomas E. Wurmb ; MD^a ; Peter Kranke ; MD^a ; Norbert Roewer ; MD^a ; Ralf M. Muellenbach ; MD^a
• 关键词：Respiratory failure ; Acute respiratory distress syndrome ; Acute lung injury ; Positive-pressure respiration ; High-frequency oscillatory ventilation ; Extracorporeal lung assist
• 刊名：Journal of Critical Care
• 出版年：2012
• 出版时间：April, 2012
• 年：2012
• 卷：27
• 期：2
• 页码：182-191
• 全文大小：603 K

文摘

Purpose

Elimination of carbon dioxide by an arteriovenous extracorporeal lung assist (av-ECLA) can facilitate the lung protective capabilities of high-frequency oscillatory ventilation (HFOV). This case series describes patients treated with HFOV because of severe respiratory failure with and without additional av-ECLA.

Methods

A retrospective analysis of 31 patients regarding patient characteristics, gas exchange, respirator settings, hemodynamics, and outcome. In 18 patients, av-ECLA was started before, together with, or during HFOV.

Results

The initial arterial carbon dioxide tension before HFOV and av-ECLA was higher in patients who received av-ECLA compared with patients without (P = .043): 65 (48-84) mm Hg and 50 (44-60) mmHg (median and interquartile range). The initial arterial oxygen tension (Pao₂)/inspiratory oxygen fraction (Fio₂) index in patients who received av-ECLA was 79 (63-133) mm Hg. The Pao₂/Fio₂ index immediately before HFOV was 84 (65-124) mm Hg (av-ECLA) and 121 (68-150) mmHg (no av-ECLA) and improved to 149 (89-231) mm Hg and 200 (117-233) mmHg during HFOV. Similarly, the oxygenation index improved. No statistically significant differences among groups were detected for Pao₂/Fio₂ index, oxygenation index, and arterial carbon dioxide tension immediately before and during HFOV. The hospital mortality was 39 % (av-ECLA) and 69 % (no av-ECLA).

Conclusions

High-frequency oscillatory ventilation improved the oxygenation in patients with severe respiratory failure. Additional av-ECLA may facilitate using lung protective HFOV settings in more severe lung injury and hypercapnia.