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High-frequency oscillation in adults: a utilization review.

AbstractOBJECTIVES:
High-frequency oscillation is used for adults with acute lung injury/acute respiratory distress syndrome. Given the uncertain benefits, our objective was to describe contemporary patient selection, high-frequency oscillation utilization, and outcomes.
DESIGN:
Utilization review.
SETTING:
Ten academic centers (Ontario, Canada; January 1, 2005-January 31, 2007).
PATIENTS:
We included 190 consecutive adults treated with high-frequency oscillation and retrospectively abstracted data on patient demographics, gas exchange, hemodynamics, settings during conventional ventilation and high-frequency oscillation, adjunctive therapies, and outcomes. We used logistic regression to explore associations with oxygenation response and hemodynamic and ventilatory complications (2 hrs after high-frequency oscillation initiation) and mortality. Continuous data are reported as mean (sd) or median (quartile 1, quartile 3).
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Patients (60.0% male; mean age, 52; sd 17) had predominantly acute lung injury/acute respiratory distress syndrome (89.8%) and were severely ill (mean Acute Physiology and Chronic Health Evaluation II score, 28; sd, 9) and hypoxemic (mean Pao2/Fio2, 80; sd, 42). High-frequency oscillation was started a median of 2 (1, 8) days after intubation and continued for a median of 3 (2, 7) days. During high-frequency oscillation, adjunctive treatments (neuromuscular blockade, 75.6%; recruitment maneuvers, 49.5%; nitric oxide, 34.0%; steroids, 63.1%) and new barotrauma or chest tube placement (23.5%) were common. Ten patients (5.3%) had technical complications; five required a new ventilator. Reasons for stopping high-frequency oscillation included death or withdrawal of life support (39.1%), significant improvement in respiratory failure (37.6%), and inadequate improvement (23.3%). One hundred and twenty-eight of 189 patients died in hospital. Most (62.5%) had a positive oxygenation response after 2 hrs of high-frequency oscillation (mean absolute increase in PaO₂/FiO₂, 22 [SD, 54]; 95% confidence interval of mean 14-31). A minority had lower PaO₂/FiO₂ (32.5%) or a hemodynamic (27.5%) or ventilatory (30.5%) complication. Older age, Acute Physiology and Chronic Health Evaluation II score, and Paco2 before high-frequency oscillation were independently associated with mortality.
CONCLUSIONS:
Most patients treated with high-frequency oscillation have acute respiratory distress syndrome and severe hypoxemia that modestly improves 2 hrs after high-frequency oscillation application. However, oxygenation worsens in some patients, complications are common, and mortality is high.
AuthorsNeill K J Adhikari, Abdel Bashir, François Lamontagne, Sangeeta Mehta, Niall D Ferguson, Qi Zhou, Lori Hand, Kasia Czarnecka, Deborah J Cook, John T Granton, Jan O Friedrich, Andreas Freitag, Irene Watpool, Maureen O Meade
JournalCritical care medicine (Crit Care Med) Vol. 39 Issue 12 Pg. 2631-44 (Dec 2011) ISSN: 1530-0293 [Electronic] United States
PMID21765359 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
Topics
  • Academic Medical Centers (statistics & numerical data)
  • Acute Lung Injury (therapy)
  • Female
  • Hemodynamics (physiology)
  • High-Frequency Ventilation (adverse effects, mortality, statistics & numerical data)
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Respiration
  • Respiratory Distress Syndrome (therapy)
  • Treatment Outcome

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