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February 28, 2013

High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome.

Mazen Kherallah

Summarized by: 

What was the research question?

  • Does high frequency oscillation ventilation improve mortality in patients with moderate to severe ARDS compared to conventional low tidal volume mechanical ventilation?

How did they do it?

  • A multicenter, randomized, controlled trial in 39 ICUs in Canada, USA, Saudi Arabia, Chile, and India.

  • Planned to randomize 1200 patients but the trial was stopped after 548 due to futility.

  • Patients with ARDS and PO2/Fio2 ratio <200, were randomized to undergo high frequency oscillation ventilation or conventional low volume mechanical ventilation.

What did they find?

  • In-hospital mortality was higher in the HFOV group and conventional group (47% versus 35%, RR 1.33; 95% confidence interval, 1.09 to 1.64; P=0.005).

  • HFOV patients received more midazolam (199 mg per day vs. 141 mg per day, P<0.001), neuromuscular blockers (83% vs. 68%, P<0.001), vasoactive drugs (91% vs. 84%, P=0.01) and for a longer period than did patients in the control group (5 days vs. 3 days, P=0.01)

  • Refractory hypoxemia was higher conventional group compared to HFOV group (14% vs. 7%, P=0.007).

Any limitations?

  • 23% of screened patients were declined by their physician’s choice

  • 12% of patients in the control group received HFOV for refractory hypoxemia.

  • Stopped early with lower number of patients than anticipated.

What does it mean?

  • HFOV may be associated with higher rate of in-hospital in moderate to severe ARDS compared to conventional low volume ventilation with high PEEP.

  • HFOV dropped out of practice based on this study and the OSCAR study. Patients with refractory hypoxemia should be considered for ECMO.


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