High-Frequency Oscillatory Ventilation for Patients
during Exudative Phase of Severe ARDS
Thummaporn Naorungroj MD*,
Warakarn Vilaichone MD*, Surat Tongyoo MD*,
Preecha Thamrongpairoj MD*, Chairat Permpikul MD*
Affiliation :
* Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : High frequency oscillatory ventilation (HFOV) is theoretically ideal for lung protective strategy ventilation
(LPSV) in acute respiratory distress syndrome (ARDS). However, recent studies revealed unsatisfactory outcomes. The
authors conducted a study to examine this phenomenon in patients with early phase of moderate to severe ARDS.
Objective : To evaluate the effectiveness of HFOV in patients with early phase of moderate to severe ARDS. The primary
outcome was 30 days all-cause mortality.
Material and Method: The study was a matched-case controlled clinical trial performed in the medical intensive care units,
Faculty of Medicine, Siriraj Hospital. The authors compared HFOV with LPSV in adult patients with the early phase of
ARDS who received mechanical ventilation less than 72 hours and had moderate to severe hypoxemia (PaO2/FiO2 ratio
less than or equal 150).
Results : Between June 2010 and February 2014, 49 patients with moderate to severe ARDS were included. Fourteen patients
who received HFOV were matched with 16 patients who received LPSV. The 30-day mortality in HFOV group was 61.5%;
while in control group, 50% (p = 0.53). The authors found use of higher doses of sedative drugs and muscle relaxants in
HFOV group. In addition, this group had high-level of mean airway pressure (mPaw). The presence of hemodynamic
instability was not different in both groups.
Conclusion : In adult patients in the early phase of moderate to severe ARDS who received mechanical ventilation for less
than 72 hours, HFOV did not decrease the 30-day mortality. Thus, this support should be only a rescue therapy for refractory
hypoxemia cases and in highly selected patients.
Keywords : Early, Exudative phase, ARDS, HFOV, High-frequency oscillatory ventilation
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