Combination of high frequency oscillatory ventilation and interventional lung assist in severe acute respiratory distress syndrome

Lubnow, Matthias; Luchner, Andreas; Philipp, Alois; Buchner, Stefan; Jeron, Andreas; Karagiannidis, Christian; Bein, Thomas; Pawlik, Michael; Jungbauer, Carsten; Schmid, Christof; Riegger, Günter A.J.; Pfeifer, Michael; Müller, Thomas

doi:10.1016/j.jcrc.2009.11.004

« Previous Next »Journal of Critical Care
Volume 25, Issue 3 , Pages 436-444, September 2010

Combination of high frequency oscillatory ventilation and interventional lung assist in severe acute respiratory distress syndrome☆

Matthias Lubnow, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
- Corresponding author. Tel.: +49 941 944 7350; fax: +49 941 944 7356.
Andreas Luchner, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
Alois Philipp
- Department of Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Stefan Buchner, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
Andreas Jeron, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
Christian Karagiannidis, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
Thomas Bein, MD
- Department of Anaesthesiology, University Hospital Regensburg, 93053 Regensburg, Germany
Michael Pawlik, MD
- Department of Anaesthesiology, University Hospital Regensburg, 93053 Regensburg, Germany
Carsten Jungbauer, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
Christof Schmid, MD
- Department of Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Günter A.J. Riegger, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
Michael Pfeifer, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
Thomas Müller, MD
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany

published online 15 January 2010.

Abstract

Background

The combination of high-frequency oscillatory ventilation (HFOV) and extracorporeal carbon dioxide removal with the interventional lung assist (iLA) in severe acute respiratory distress syndrome (ARDS) represents a novel treatment option.

Methods

The study used a retrospective single-center analysis of 21 consecutive adult patients with severe ARDS, ventilated with HFOV/iLA. Efficiency, side effects, and outcome of combined treatment are presented as median (interquartile range).

Measurements and Main Results

The following were used to determine patient characteristics: sequential organ failure assessment score, 14; simplified acute physiology score II, 41; and Murray score, 4. The duration of combined treatment was 6 days. The blood flow through the iLA was 1.9 L/min.

The Pao₂/inspired fraction of oxygen ratio increased from 61 (47-86) to 98 (67-116) within 2 hours and to 106 (70-135) mm Hg at 24 hours. Paco₂ decreased from 58 (50-76) to 37 (29-47) mm Hg at 2 hours with normalization of pH 7.28 (7.16-7.36) to 7.43 (7.33-7.49) after 2 hours associated with hemodynamic stabilization. In 6 patients, complications due to iLA treatment were observed, and in 3 patients, complications associated with HFOV were seen. Weaning from HFOV/iLA was successful in 10 patients. The 30-day mortality rate was 43%, and hospital mortality rate was 57%.

Conclusion

The combination of HFOV/iLA is an option in severe pulmonary failure if conventional ventilation fails and pumpdriven extracorporeal membrane oxygenation therapy is not available.

Keywords: ARDS, Carbon dioxide removal, HFOV, High-frequency oscillatory ventilation, iLA, Interventional lung assist