High-frequency Oscillatory Ventilation Following Prone Positioning Prevents a Further Impairment in Oxygenation

Crit Care Med. 2007 Jan;35(1):106-11. doi: 10.1097/01.CCM.0000251128.60336.FE.

Abstract

Objective: The improvement in oxygenation with prone positioning is not persistent when patients with acute respiratory distress syndrome (ARDS) are turned supine. High-frequency oscillatory ventilation (HFOV) aims to maintain an open lung volume by the application of a constant mean airway pressure. The aim of this study was to show that HFOV is able to prevent the impairment in oxygenation when ARDS patients are turned back from the prone to the supine position.

Design: Prospective, comparative randomized study.

Setting: A medical intensive care unit.

Patients: Forty-three ARDS patients with a Pao2/Fio2 ratio <150 at positive end-expiratory pressure > or =5 cm H2O.

Interventions: After an optimization period, the patients were assigned to one of three groups: a) conventional lung-protective mechanical ventilation in the prone position (12 hrs) followed by a 12-hr period of conventional lung-protective mechanical ventilation in the supine position (CV(prone)-CV(supine)); b) conventional lung-protective mechanical ventilation in the supine position (12 hrs) followed by HFOV in the supine position (12 hrs) (CV(supine)-HFOV(supine)); or c) conventional lung-protective mechanical ventilation in the prone position (12 hrs) followed by HFOV in the supine position (CV(prone)-HFOV(supine) group).

Measurements and main results: Pao2/Fio2 ratio was higher at the end of the study period in the CV(prone)-HFOV(supine) group than in the CV(prone)-CV(supine) group (p < .02). Venous admixture at the end of the study period was lower in the CV(prone)-HFOV(supine) group than in the two other groups.

Conclusions: HFOV maintained the improvement in oxygenation related to prone positioning when ARDS patients were returned to the supine position.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analysis of Variance
  • Blood Gas Analysis
  • Critical Care / methods
  • Female
  • France
  • High-Frequency Ventilation / methods*
  • Hospitals, University
  • Humans
  • Male
  • Middle Aged
  • Prone Position*
  • Prospective Studies
  • Pulmonary Gas Exchange
  • Respiration, Artificial / methods
  • Respiratory Distress Syndrome, Adult / diagnosis
  • Respiratory Distress Syndrome, Adult / metabolism
  • Respiratory Distress Syndrome, Adult / physiopathology
  • Respiratory Distress Syndrome, Adult / therapy*
  • Supine Position
  • Tidal Volume
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome