Efficacy and adverse events of early high-frequency oscillatory ventilation in adult burn patients with acute respiratory distress syndrome

Background: High-frequency oscillatory ventilation (HFOV) is one of lung protective strategies in acute respiratory distress syndrome (ARDS). It is not recommended to be used as initial mode of ventilation. Previous studies showed conflicting results for late use of HFOV (after prolonged period of conventional mechanical ventilation (CMV)). This study investigated the use of HFOV as an early therapy (after 24 h of CMV) in the management of ARDS due to burn. Methods: 70 burned ARDS patients were ventilated by CMV during the first 24 h (Day 0). Then, patients were randomly allocated into two equal groups (35 each): Group 1 (G 1 or CMV): they continued on CMV. Group 2 (G2 or HFOV): HFOV was instituted for 72 h (Days 1, 2, 3). Then, patients were shifted to CMV on Day 4 to continue on CMV. Ventilator settings, gas exchange parameters, hemodynamics, sedatives, vasoactive and paralytic requirements, barotraumas and hospital mortality were recorded and compared between the two groups. Results: In Day 0: Demographic data, ventilator settings, gas exchange parameters, and hemodynamics showed no significant difference between both groups. Days 1, 2, 3: there was statistically significant decrease of FiO(2) and OI accompanied by an increase in PaO2, PaO2/FiO(2) and PaCO2 in G2. Day 4: while both groups on CMV, G2 patients showed statistically significant decrease in PEEP and mPaw with same gas exchange findings on Days 1, 2, 3 between two groups. During the study period, Hypotension was observed following HFOV in G2 and was most significant in Day 1. G2 showed statistically significant increase in barotraumas and required more midazolam, atracurium and norepinephrine. There was no statistically significant difference in 30 days mortality between both groups. Conclusions: Early HFOV therapy is effective in improving oxygenation in burn patients with ARDS, but it failed to reduce hospital mortality. (C) 2016 Publishing services by Elsevier B. V. on behalf of Egyptian Society of Anesthesiologists.