High-frequency oscillatory ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

2012 | journal article. A publication with affiliation to the University of Göttingen.

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​High-frequency oscillatory ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease​
Frerichs, I.; Achtzehn, U.; Pechmann, A.; Pulletz, S.; Schmidt, E. W.; Quintel, M. & Weiler, N.​ (2012) 
Journal of Critical Care27(2) pp. 172​-181​.​ DOI: https://doi.org/10.1016/j.jcrc.2011.04.008 

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Authors
Frerichs, Inez; Achtzehn, Ute; Pechmann, Andreas; Pulletz, Sven; Schmidt, Ernst W.; Quintel, Michael; Weiler, Norbert
Abstract
Purpose: High-frequency oscillatory ventilation (HFOV) is usually considered not indicated for treatment of patients with chronic obstructive pulmonary disease (COPD) because of the theoretical risk of air trapping and hyperinflation. The aim of our study was to establish whether HFOV can be safely applied in patients with acute exacerbation of COPD and hypercapnic respiratory failure. Methods: Ten patients (age, 63-83 years) requiring intensive care treatment who failed on noninvasive ventilation were studied. After initial conventional mechanical ventilation (CMV) of less than 72 hours, all patients were transferred to HFOV for 24 hours and then back to CMV. Arterial blood gases, spirometry, and hemodynamic parameters were repeatedly obtained in all phases of CMV and HFOV at different settings. Regional lung aeration and ventilation were assessed by electrical impedance tomography. Results: High-frequency oscillatory ventilation was tolerated well; no adverse effects or severe hyperinflation and hemodynamic compromise were observed. Effective CO2 elimination and oxygenation were achieved. Ventilation was more homogeneously distributed during HFOV than during initial CMV. Higher respiratory system compliance and tidal volume were found during CMV after 24 hours of HFOV. Conclusions: Our study indicates that short-term HFOV, using lower mean airway pressures than recommended for acute respiratory distress syndrome, appears safe in patients with COPD while securing adequate pulmonary gas exchange. (C) 2012 Elsevier Inc. All rights reserved.
Issue Date
2012
Status
published
Publisher
W B Saunders Co-elsevier Inc
Journal
Journal of Critical Care 
ISSN
0883-9441
Sponsor
Viasys Healthcare; CareFusion; Novalung

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