High frequency oscillatory ventilation in burn patients with the acute respiratory distress syndrome

Abstract 

Background: High frequency oscillatory ventilation (HFOV) improves gas exchange while providing lung protective effects during the ventilation of patients with the acute respiratory distress syndrome (ARDS). The purpose of this study was to review our experience with HFOV in adult burn patients with oxygenation failure secondary to ARDS. Methods: Retrospective cohort review of all burn patients treated with HFOV at a regional adult burn center. Results: All values are reported as the (S.D.). HFOV was used on 28 occasions in 25 patients (age 44±16 years, %TBSA burns 40±15, and a 28% incidence of inhalation injury) who had severe oxygenation failure from ARDS (PaO₂/FiO₂ ratio 98±26, and oxygenation index (OI) (FiO₂×100×mean airway pressure/PaO₂) 27±10) following 4.8±4.4 days of conventional mechanical ventilation (CMV). After switching from CMV to HFOV, there were significant improvements in the PaO₂/FiO₂ ratio within 1h and in the oxygenation index within 24h. The duration of HFOV was 6.1±5.8 days. HFOV was continued during 26 surgeries for 14 patients where a mean of 18±9% TBSA burns were excised and closed. The only complications related to HFOV were three episodes of severe hypercapnia. In-hospital mortality was 32%. Conclusions: HFOV was safe, and was highly effective in correcting oxygenation failure associated with ARDS in burn patients, and can be successfully used as an intra-operative ventilation modality for burn patients.

Keywords:  Ventilation, ARDS, Lung injury, Burns