Giuseppe
Emeritus
[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]
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Original Article
High-Frequency Oscillation for Acute Respiratory Distress Syndrome
Duncan Young, D.M., Sallie 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
January 22, 2013 - DOI: 10.1056/NEJMoa1215716
Abstract
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.)
-High-Frequency Oscillation for Acute Respiratory Distress Syndrome
Duncan Young, D.M., Sallie 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
January 22, 2013 - DOI: 10.1056/NEJMoa1215716
Abstract
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.)
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