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N Engl J Med. High-Frequency Oscillation for Acute Respiratory Distress Syndrome
[Source: New England Journal of Medicine, full text: (LINK). Abstract, edited.]
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Original Article
High-Frequency Oscillation for Acute Respiratory Distress Syndrome
Duncan Young, D.M., Sarah E. Lamb, D.Phil., Sanjoy Shah, M.D., Iain MacKenzie, M.D., William Tunnicliffe, M.Sc., Ranjit Lall, Ph.D., Kathy Rowan, D.Phil., and Brian H. Cuthbertson, M.D. for the OSCAR Study Group
N Engl J Med 2013; 368:806-813 February 28, 2013 DOI: 10.1056/NEJMoa1215716
Background
Patients with the acute respiratory distress syndrome (ARDS) require mechanical ventilation to maintain arterial oxygenation, but this treatment may produce secondary lung injury. High-frequency oscillatory ventilation (HFOV) may reduce this secondary damage.
Methods
In a multicenter study, we randomly assigned adults requiring mechanical ventilation for ARDS to undergo either HFOV with a Novalung R100 ventilator (Metran) or usual ventilatory care. All the patients had a ratio of the partial pressure of arterial oxygen (PaO<SUB>2</SUB>) to the fraction of inspired oxygen (FiO<SUB>2</SUB>) of 200 mm Hg (26.7 kPa) or less and an expected duration of ventilation of at least 2 days. The primary outcome was all-cause mortality 30 days after randomization.
Results
There was no significant between-group difference in the primary outcome, which occurred in 166 of 398 patients (41.7%) in the HFOV group and 163 of 397 patients (41.1%) in the conventional-ventilation group (P=0.85 by the chi-square test). After adjustment for study center, sex, score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, and the initial PaO<SUB>2</SUB>:FiO<SUB>2</SUB> ratio, the odds ratio for survival in the conventional-ventilation group was 1.03 (95% confidence interval, 0.75 to 1.40; P=0.87 by logistic regression).
Conclusions
The use of HFOV had no significant effect on 30-day mortality in patients undergoing mechanical ventilation for ARDS. (Funded by the National Institute for Health Research Health Technology Assessment Programme; OSCAR Current Controlled Trials number, ISRCTN10416500.)
Supported by the National Institute for Health Research Health Technology Assessment Programme (project number 06/04/01).
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on January 22, 2013, and updated on January 31, 2013, at NEJM.org.
Source Information
From John Radcliffe Hospital (D.Y.) and the University of Oxford (D.Y., S.E.L.), Oxford; the Bristol Royal Infirmary, Bristol (S.S.); Queen Elizabeth Hospital, Birmingham (I.M., W.T.); Warwick Clinical Trials Unit, University of Warwick, Warwick (R.L.); and Intensive Care National Audit and Research Centre, London (K.R.) ? all in the United Kingdom; and the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and the Department of Anesthesia, University of Toronto, Toronto (B.H.C.).
Address reprint requests to Dr. Young at the Adult Intensive Care Unit, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom, or at duncan.young@nda.ox.ac.uk.
Investigators in the Oscillation in ARDS (OSCAR) study group are listed in the Supplementary Appendix, available at NEJM.org.
-High-Frequency Oscillation for Acute Respiratory Distress Syndrome
Duncan Young, D.M., Sarah E. Lamb, D.Phil., Sanjoy Shah, M.D., Iain MacKenzie, M.D., William Tunnicliffe, M.Sc., Ranjit Lall, Ph.D., Kathy Rowan, D.Phil., and Brian H. Cuthbertson, M.D. for the OSCAR Study Group
N Engl J Med 2013; 368:806-813 February 28, 2013 DOI: 10.1056/NEJMoa1215716
Background
Patients with the acute respiratory distress syndrome (ARDS) require mechanical ventilation to maintain arterial oxygenation, but this treatment may produce secondary lung injury. High-frequency oscillatory ventilation (HFOV) may reduce this secondary damage.
Methods
In a multicenter study, we randomly assigned adults requiring mechanical ventilation for ARDS to undergo either HFOV with a Novalung R100 ventilator (Metran) or usual ventilatory care. All the patients had a ratio of the partial pressure of arterial oxygen (PaO<SUB>2</SUB>) to the fraction of inspired oxygen (FiO<SUB>2</SUB>) of 200 mm Hg (26.7 kPa) or less and an expected duration of ventilation of at least 2 days. The primary outcome was all-cause mortality 30 days after randomization.
Results
There was no significant between-group difference in the primary outcome, which occurred in 166 of 398 patients (41.7%) in the HFOV group and 163 of 397 patients (41.1%) in the conventional-ventilation group (P=0.85 by the chi-square test). After adjustment for study center, sex, score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, and the initial PaO<SUB>2</SUB>:FiO<SUB>2</SUB> ratio, the odds ratio for survival in the conventional-ventilation group was 1.03 (95% confidence interval, 0.75 to 1.40; P=0.87 by logistic regression).
Conclusions
The use of HFOV had no significant effect on 30-day mortality in patients undergoing mechanical ventilation for ARDS. (Funded by the National Institute for Health Research Health Technology Assessment Programme; OSCAR Current Controlled Trials number, ISRCTN10416500.)
Supported by the National Institute for Health Research Health Technology Assessment Programme (project number 06/04/01).
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on January 22, 2013, and updated on January 31, 2013, at NEJM.org.
Source Information
From John Radcliffe Hospital (D.Y.) and the University of Oxford (D.Y., S.E.L.), Oxford; the Bristol Royal Infirmary, Bristol (S.S.); Queen Elizabeth Hospital, Birmingham (I.M., W.T.); Warwick Clinical Trials Unit, University of Warwick, Warwick (R.L.); and Intensive Care National Audit and Research Centre, London (K.R.) ? all in the United Kingdom; and the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and the Department of Anesthesia, University of Toronto, Toronto (B.H.C.).
Address reprint requests to Dr. Young at the Adult Intensive Care Unit, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom, or at duncan.young@nda.ox.ac.uk.
Investigators in the Oscillation in ARDS (OSCAR) study group are listed in the Supplementary Appendix, available at NEJM.org.
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