High-frequency oscillatory ventilation with and without arteriovenous extracorporeal lung assist in patients with severe respiratory failure

Kredel, Markus; Brederlau, Joerg; Wunder, Christian; Wurmb, Thomas E.; Kranke, Peter; Roewer, Norbert; Muellenbach, Ralf M.

doi:10.1016/j.jcrc.2011.08.007

« Previous Next »Journal of Critical Care
Volume 27, Issue 2 , Pages 182-191, April 2012

High-frequency oscillatory ventilation with and without arteriovenous extracorporeal lung assist in patients with severe respiratory failure

Markus Kredel, MD
- University of Würzburg, Department of Anaesthesia and Critical Care, 97080 Würzburg, Germany
- Corresponding author. Klinik und Poliklinik für Anästhesiologie, Zentrum für Operative Medizin, Oberdürrbacherstr. 6, 97080 Würzburg, Germany. Tel.: +49 931 201 0; fax: +49 931 201 30063.
Joerg Brederlau, MD
- HELIOS Klinikum Berlin-Buch, Department of Intensive Care Medicine, 13125 Berlin, Germany
Christian Wunder, MD
- University of Würzburg, Department of Anaesthesia and Critical Care, 97080 Würzburg, Germany
Thomas E. Wurmb, MD
- University of Würzburg, Department of Anaesthesia and Critical Care, 97080 Würzburg, Germany
Peter Kranke, MD
- University of Würzburg, Department of Anaesthesia and Critical Care, 97080 Würzburg, Germany
Norbert Roewer, MD
- University of Würzburg, Department of Anaesthesia and Critical Care, 97080 Würzburg, Germany
Ralf M. Muellenbach, MD
- University of Würzburg, Department of Anaesthesia and Critical Care, 97080 Würzburg, Germany

published online 28 October 2011.

Abstract

Purpose

Elimination of carbon dioxide by an arteriovenous extracorporeal lung assist (av-ECLA) can facilitate the lung protective capabilities of high-frequency oscillatory ventilation (HFOV). This case series describes patients treated with HFOV because of severe respiratory failure with and without additional av-ECLA.

Methods

A retrospective analysis of 31 patients regarding patient characteristics, gas exchange, respirator settings, hemodynamics, and outcome. In 18 patients, av-ECLA was started before, together with, or during HFOV.

Results

The initial arterial carbon dioxide tension before HFOV and av-ECLA was higher in patients who received av-ECLA compared with patients without (P = .043): 65 (48-84) mm Hg and 50 (44-60) mmHg (median and interquartile range). The initial arterial oxygen tension (Pao₂)/inspiratory oxygen fraction (Fio₂) index in patients who received av-ECLA was 79 (63-133) mm Hg. The Pao₂/Fio₂ index immediately before HFOV was 84 (65-124) mm Hg (av-ECLA) and 121 (68-150) mmHg (no av-ECLA) and improved to 149 (89-231) mm Hg and 200 (117-233) mmHg during HFOV. Similarly, the oxygenation index improved. No statistically significant differences among groups were detected for Pao₂/Fio₂ index, oxygenation index, and arterial carbon dioxide tension immediately before and during HFOV. The hospital mortality was 39% (av-ECLA) and 69% (no av-ECLA).

Conclusions

High-frequency oscillatory ventilation improved the oxygenation in patients with severe respiratory failure. Additional av-ECLA may facilitate using lung protective HFOV settings in more severe lung injury and hypercapnia.

Keywords: Respiratory failure, Acute respiratory distress syndrome, Acute lung injury, Positive-pressure respiration, High-frequency oscillatory ventilation, Extracorporeal lung assist