High-frequency oscillatory ventilation as a rescue therapy for adult trauma patients

• Published in: American journal of critical care Vol. 18; no. 2; pp. 144 - 148
• Main Authors: Briggs, Steven, Goettler, Claudia E, Schenarts, Paul J, Newell, Mark A, Sagraves, Scott G, Bard, Michael R, Toschlog, Eric A, Rotondo, Michael F
• Format: Journal Article
• Language: English
• Published: United States 01-03-2009
• Subjects: Blood Gas Analysis; High-Frequency Ventilation - statistics & numerical data; Humans; Injury Severity Score; Length of Stay; Nursing; Retrospective Studies; Survival Analysis; Trauma Centers; Wounds and Injuries - mortality; Wounds and Injuries - therapy
• ISSN: 1062-3264; 1937-710X
• DOI: 10.4037/ajcc2009303

High-frequency oscillatory ventilation is an alternative ventilation mode that improves oxygenation in trauma patients in whom conventional ventilation strategies have been unsuccessful.
To evaluate the effect of high-frequency oscillatory ventilation on oxygenation, survival, and parameters predictive of survival in trauma patients.
A retrospective case series of 24 adult patients admitted to the trauma intensive care unit at a level I trauma center between November 2001 and July 2005 and treated with high-frequency oscillatory ventilation. Survivors and nonsurvivors were compared for mechanism and severity of injury, oxygenation parameters related to high-frequency oscillatory ventilation, and hospital course.
Of the 8577 patients admitted during the study period, acute respiratory distress syndrome developed in 103 (1%). Of those 103 patients, 24 (23%) were treated with high-frequency oscillatory ventilation. Most of the patients treated with high-frequency oscillatory ventilation had sustained blunt trauma (79%). Oxygenation parameters improved significantly with high-frequency oscillatory ventilation in all patients, regardless of survival. Of the 24 patients treated with this ventilation mode, 15 (62%) survived. Survival did not correlate with improved oxygenation parameters but with the number of failed organ systems and injury severity.
Although high-frequency oscillatory ventilation improves oxygenation, severity of traumatic injury and organ failure, not respiratory parameters, are predictors of survival. High-frequency oscillatory ventilation should be considered for pulmonary rescue of severely injured patients with acute respiratory distress syndrome.