Role of High frequency oscillatory ventilation in Trauma
Recent study by Funk in Journal of trauma-injury & critical care helped to shed light on this area.
Background: Severe pulmonary contusions are a common cause of acute respiratory distress syndrome (ARDS) and are associated with significant morbidity. High frequency oscillatory ventilation (HFOV) is a ventilatory mode that employs a lung protective strategy consistent with the ARDSNet low tidal volume ventilation strategy and may result in reduced morbidity. The objective of this report is to examine the impact of HFOV on blunt trauma patients with severe pulmonary contusions who failed or were at a high risk of failing conventional mechanical ventilation.
Methods: We undertook a retrospective chart review of all patients at our institution who received HFOV for severe pulmonary contusions. Patients were placed on HFOV when their mean airway pressure (mPaw) surpassed 30 cm H2O and their FIO2 was greater than 0.6. Serial determinations were made upto 72 hours of
- oxygenation index (OI) and
- the Pao2/FIO2 ratio (P/F)
A linear mixed model was used to analyze the slope ([beta]) of the regression line of P/F versus time and that of OI versus time.
Results: 17 patients were identified who underwent HFOV for ARDS due primarily to pulmonary contusions.
- P/F increased significantly after HFOV was initiated ([beta] = 12.1
- OI significantly decreased after HFOV implementation ([beta] = -1.8
- Mortality rate was 17.6%
Conclusions: The early use of HFOV appears to be safe and efficacious in blunt trauma patients sustaining pulmonary contusions, and results in a rapid improvement in OI and the P/F ratio.
Reference: click to get abstract
Funk D, Lujan E, Moretti EW, Davies J, Young C, Patel M, Vaslef S. A brief report: The use of high-frequency oscillatory ventilation for severe pulmonary contusion. Journal of Trauma-Injury & critical Care 2008; 65(2): 390-395
