High-frequency oscillatory ventilation in adults: The Toronto Experience

To review the clinical experience with high-frequency oscillatory ventilation (HFOV) in three medical-surgical ICUs in Toronto, ON, Canada, and to describe patient characteristics, HFOV strategies, and outcomes. Retrospective chart review of all patients treated with HFOV at three academic universit...

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Veröffentlicht in:Chest 2004-08, Vol.126 (2), p.518-527
Hauptverfasser: MEHTA, Sangeeta, GRANTON, John, MACDONALD, Rod J, BOWMAN, Dennis, MATTE-MARTYN, Andrea, BACHMAN, Thomas, SMITH, Terry, STEWART, Thomas E
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container_end_page 527
container_issue 2
container_start_page 518
container_title Chest
container_volume 126
creator MEHTA, Sangeeta
GRANTON, John
MACDONALD, Rod J
BOWMAN, Dennis
MATTE-MARTYN, Andrea
BACHMAN, Thomas
SMITH, Terry
STEWART, Thomas E
description To review the clinical experience with high-frequency oscillatory ventilation (HFOV) in three medical-surgical ICUs in Toronto, ON, Canada, and to describe patient characteristics, HFOV strategies, and outcomes. Retrospective chart review of all patients treated with HFOV at three academic university-affiliated ICUs since 1998. The data extracted included patient demographics, etiology of respiratory failure, ventilator settings, and gas exchange and cardiovascular data from baseline to 72 h of treatment, as well as at the transition from HFOV to conventional ventilation (CV). Heart rate and BP were recorded at regular intervals in all patients, and hemodynamic data were recorded in 32 patients who had pulmonary artery catheters in place. Cointerventions and ICU mortality were also recorded. A total of 156 adults (67 women and 89 men; mean [+/- SD] age, 48 +/- 18 years; mean acute physiology and chronic health evaluation [APACHE] II score, 23.8 +/- 7.5) with severe ARDS (ie, mean Pao(2)/fraction of inspired oxygen [Fio(2)] ratio, 91 +/- 48 mm Hg; mean oxygenation index [OI], 31 +/- 14) who had received CV for a duration of 5.6 +/- 7.6 days underwent 171 trials of HFOV. HFOV was discontinued within 4 h in 19 patients (12%) because of difficulties with oxygenation, ventilation, or hemodynamics. Pao(2)/Fio(2) ratios and OI ([Fio(2) x mean airway pressure x 100]/Pao(2)) improved significantly with the application of HFOV, and this benefit persisted for the 72-h study duration. Significant changes in hemodynamics following HFOV initiation included an increase in central venous pressure and a reduction in cardiac output (throughout the 72 h), and an increase in pulmonary artery occlusion pressure (at 3 and 6 h). Patients were treated with HFOV for 5.1 +/- 6.3 days. The 30-day mortality rate was 61.7%. Pneumothorax occurred in 21.8% of patients, 43.6% of patients were treated with inhaled nitric oxide, and 37.2% of patients were treated with steroids. Independent predictors of mortality on multivariate analysis were older age, higher APACHE II score, lower pH at the initiation of HFOV, and a greater number of days receiving CV prior to HFOV. HFOV has beneficial effects on Pao(2)/Fio(2) ratios and OI, and may be an effective rescue therapy for adults with severe oxygenation failure. The early institution of HFOV may be advantageous.
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Vascular system ; Central Venous Pressure ; Clinical outcomes ; Female ; Hemodynamics ; High-Frequency Ventilation ; Humans ; Intensive Care Units ; Male ; Medical sciences ; Middle Aged ; Mortality ; Nitric oxide ; Patient outcomes ; Patients ; Physiology ; Pneumology ; Pulmonary arteries ; Pulmonary function tests ; Respiratory Distress Syndrome, Adult - mortality ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory failure ; Respiratory system : syndromes and miscellaneous diseases ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Veins &amp; arteries ; Ventilators ; Ventilators, Mechanical</subject><ispartof>Chest, 2004-08, Vol.126 (2), p.518-527</ispartof><rights>2004 INIST-CNRS</rights><rights>COPYRIGHT 2004 Elsevier B.V.</rights><rights>Copyright American College of Chest Physicians Aug 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=16001407$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15302739$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MEHTA, Sangeeta</creatorcontrib><creatorcontrib>GRANTON, John</creatorcontrib><creatorcontrib>MACDONALD, Rod J</creatorcontrib><creatorcontrib>BOWMAN, Dennis</creatorcontrib><creatorcontrib>MATTE-MARTYN, Andrea</creatorcontrib><creatorcontrib>BACHMAN, Thomas</creatorcontrib><creatorcontrib>SMITH, Terry</creatorcontrib><creatorcontrib>STEWART, Thomas E</creatorcontrib><title>High-frequency oscillatory ventilation in adults: The Toronto Experience</title><title>Chest</title><addtitle>Chest</addtitle><description>To review the clinical experience with high-frequency oscillatory ventilation (HFOV) in three medical-surgical ICUs in Toronto, ON, Canada, and to describe patient characteristics, HFOV strategies, and outcomes. Retrospective chart review of all patients treated with HFOV at three academic university-affiliated ICUs since 1998. The data extracted included patient demographics, etiology of respiratory failure, ventilator settings, and gas exchange and cardiovascular data from baseline to 72 h of treatment, as well as at the transition from HFOV to conventional ventilation (CV). Heart rate and BP were recorded at regular intervals in all patients, and hemodynamic data were recorded in 32 patients who had pulmonary artery catheters in place. Cointerventions and ICU mortality were also recorded. A total of 156 adults (67 women and 89 men; mean [+/- SD] age, 48 +/- 18 years; mean acute physiology and chronic health evaluation [APACHE] II score, 23.8 +/- 7.5) with severe ARDS (ie, mean Pao(2)/fraction of inspired oxygen [Fio(2)] ratio, 91 +/- 48 mm Hg; mean oxygenation index [OI], 31 +/- 14) who had received CV for a duration of 5.6 +/- 7.6 days underwent 171 trials of HFOV. HFOV was discontinued within 4 h in 19 patients (12%) because of difficulties with oxygenation, ventilation, or hemodynamics. Pao(2)/Fio(2) ratios and OI ([Fio(2) x mean airway pressure x 100]/Pao(2)) improved significantly with the application of HFOV, and this benefit persisted for the 72-h study duration. Significant changes in hemodynamics following HFOV initiation included an increase in central venous pressure and a reduction in cardiac output (throughout the 72 h), and an increase in pulmonary artery occlusion pressure (at 3 and 6 h). Patients were treated with HFOV for 5.1 +/- 6.3 days. The 30-day mortality rate was 61.7%. Pneumothorax occurred in 21.8% of patients, 43.6% of patients were treated with inhaled nitric oxide, and 37.2% of patients were treated with steroids. Independent predictors of mortality on multivariate analysis were older age, higher APACHE II score, lower pH at the initiation of HFOV, and a greater number of days receiving CV prior to HFOV. 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Vascular system</topic><topic>Central Venous Pressure</topic><topic>Clinical outcomes</topic><topic>Female</topic><topic>Hemodynamics</topic><topic>High-Frequency Ventilation</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nitric oxide</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Physiology</topic><topic>Pneumology</topic><topic>Pulmonary arteries</topic><topic>Pulmonary function tests</topic><topic>Respiratory Distress Syndrome, Adult - mortality</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory failure</topic><topic>Respiratory system : syndromes and miscellaneous diseases</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Veins &amp; arteries</topic><topic>Ventilators</topic><topic>Ventilators, Mechanical</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MEHTA, Sangeeta</creatorcontrib><creatorcontrib>GRANTON, John</creatorcontrib><creatorcontrib>MACDONALD, Rod J</creatorcontrib><creatorcontrib>BOWMAN, Dennis</creatorcontrib><creatorcontrib>MATTE-MARTYN, Andrea</creatorcontrib><creatorcontrib>BACHMAN, Thomas</creatorcontrib><creatorcontrib>SMITH, Terry</creatorcontrib><creatorcontrib>STEWART, Thomas E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MEHTA, Sangeeta</au><au>GRANTON, John</au><au>MACDONALD, Rod J</au><au>BOWMAN, Dennis</au><au>MATTE-MARTYN, Andrea</au><au>BACHMAN, Thomas</au><au>SMITH, Terry</au><au>STEWART, Thomas E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-frequency oscillatory ventilation in adults: The Toronto Experience</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>2004-08</date><risdate>2004</risdate><volume>126</volume><issue>2</issue><spage>518</spage><epage>527</epage><pages>518-527</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>To review the clinical experience with high-frequency oscillatory ventilation (HFOV) in three medical-surgical ICUs in Toronto, ON, Canada, and to describe patient characteristics, HFOV strategies, and outcomes. Retrospective chart review of all patients treated with HFOV at three academic university-affiliated ICUs since 1998. The data extracted included patient demographics, etiology of respiratory failure, ventilator settings, and gas exchange and cardiovascular data from baseline to 72 h of treatment, as well as at the transition from HFOV to conventional ventilation (CV). Heart rate and BP were recorded at regular intervals in all patients, and hemodynamic data were recorded in 32 patients who had pulmonary artery catheters in place. Cointerventions and ICU mortality were also recorded. A total of 156 adults (67 women and 89 men; mean [+/- SD] age, 48 +/- 18 years; mean acute physiology and chronic health evaluation [APACHE] II score, 23.8 +/- 7.5) with severe ARDS (ie, mean Pao(2)/fraction of inspired oxygen [Fio(2)] ratio, 91 +/- 48 mm Hg; mean oxygenation index [OI], 31 +/- 14) who had received CV for a duration of 5.6 +/- 7.6 days underwent 171 trials of HFOV. HFOV was discontinued within 4 h in 19 patients (12%) because of difficulties with oxygenation, ventilation, or hemodynamics. Pao(2)/Fio(2) ratios and OI ([Fio(2) x mean airway pressure x 100]/Pao(2)) improved significantly with the application of HFOV, and this benefit persisted for the 72-h study duration. Significant changes in hemodynamics following HFOV initiation included an increase in central venous pressure and a reduction in cardiac output (throughout the 72 h), and an increase in pulmonary artery occlusion pressure (at 3 and 6 h). Patients were treated with HFOV for 5.1 +/- 6.3 days. The 30-day mortality rate was 61.7%. Pneumothorax occurred in 21.8% of patients, 43.6% of patients were treated with inhaled nitric oxide, and 37.2% of patients were treated with steroids. Independent predictors of mortality on multivariate analysis were older age, higher APACHE II score, lower pH at the initiation of HFOV, and a greater number of days receiving CV prior to HFOV. HFOV has beneficial effects on Pao(2)/Fio(2) ratios and OI, and may be an effective rescue therapy for adults with severe oxygenation failure. The early institution of HFOV may be advantageous.</abstract><cop>Northbrook, IL</cop><pub>American College of Chest Physicians</pub><pmid>15302739</pmid><doi>10.1378/chest.126.2.518</doi><tpages>10</tpages></addata></record>
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subjects Age Factors
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
APACHE
Biological and medical sciences
Cardiac Output
Cardiology. Vascular system
Central Venous Pressure
Clinical outcomes
Female
Hemodynamics
High-Frequency Ventilation
Humans
Intensive Care Units
Male
Medical sciences
Middle Aged
Mortality
Nitric oxide
Patient outcomes
Patients
Physiology
Pneumology
Pulmonary arteries
Pulmonary function tests
Respiratory Distress Syndrome, Adult - mortality
Respiratory Distress Syndrome, Adult - therapy
Respiratory failure
Respiratory system : syndromes and miscellaneous diseases
Retrospective Studies
Time Factors
Treatment Outcome
Veins & arteries
Ventilators
Ventilators, Mechanical
title High-frequency oscillatory ventilation in adults: The Toronto Experience
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