medigraphic.com
ISSN 2448-8909 (Print)

2011, Number 1

<< Back Next >>

Med Crit 2011; 25 (1)

High-frequency oscillation in patients with serious pneumonia secondary to human AH1N1 influenza and hypoxemia refractory to conventional mechanical ventilation

Carrillo ER, Arch TE, Garnica EMA

Language: Spanish
References: 35
Page: 33-40
PDF size: 270.78 Kb.


ABSTRACT

Introduction: Pneumonia secondary to H1N1 can lead to primary ARDS and Hypoxemia refractory to conventional ventilation. In these cases the high frequency oscillatory ventilation (HFOV) can be a good therapeutic alternative.
Objective: To describe the evolution and response of patients with influenza A H1N1-induced pneumonia and hypoxemia refractory to conventional ventilation treated with HFOV.
Method: Two patients with severe pneumonia with hypoxemia refractory to conventional ventilation, which was defined as PaO2 levels ‹ 80 mmHg with FiO2 › 80% during pressure-controlled ventilation with a protective and maximal recruitment strategy, with positive end-expiratory pressure (PEEP) of › 20 cmH2O, tidal volume (TV) between 6 to 8 mL/kg and respiratory frequency between 15 to 18/minute. The HFOV was programmed initially with 5 Hertz (Hz), mean airway pressure (MAP) of 25 mmHg and inspired oxygen fraction of 100%, which decreased in accordance to the evolution until the 40% was reached. Respiratory and hemodynamic parameters were evaluated before and after the HFOV, these parameters were: PaO2, SaO2, Kirby Index (KI), arterial pressure of carbon dioxide (PACO2), shunts (Qs,Qt). The hemodynamic parameters were: Central venous oxygen saturation ScvO2, cardiac output (CO), cardiac index (CI) and systolic volume variation (SVV).
Results: The HFOV significantly increased the PaO2 from 80 mmHg to 100 mmHg (p = 0.011), the KI, the ScvO2 and was associated with the decrease of intrapulmonary shunt. During the ventilatory procedure hemodynamic deterioration was not present, which was evident due to the SVV normalization and the upkeep of the CO and CI, both patients survived.
Conclusion: The HFOV is a good ventilatory alternative for patients with severe pneumonia secondary to the virus of AH1N1 influenza with hypoxemia refractory to conventional ventilation.


REFERENCES

  1. Secretaría de Salud (SSA). Plan Nacional de Preparación y Respuesta ante una Pandemia de Influenza. México 2006. [Consultado 2009 agosto 13]. Disponible en: www.cenavece.salud.gob.mx/emergencias/flu-index.htm

  2. Bridges CB, Lim W, Hu-Primmer J, Sims L, Fukuda K, Mar KH, et al. Risk of influenza A (H5N1) infection among popultry workers, Hong Kong, 1997-1998. J Infect Dis 2002;185:1005-1010.

  3. World Health Organization (WHO). Pandemic Influenza Preparedness and Response. The WHO Pandemic Phases. A WHO guidance document. April 2009.www.who.int/csr/disease/influenza/pipguidance2009/en/index.html

  4. Díaz MP, Mújica MF, Olvera A, González DJ, Montealegre PA, Moreno A, et al. Síndrome de insuficiencia respiratoria aguda (SIRA). Rev Asoc Mex Med Crit y Ter Int 2004;18:24-33.

  5. Rüdger KR, Kuhlen R, Max M, Rossaint R. Evidence-based medicine in the therapy of the acute respiratory distress syndrome Intensive Care Med 2002;28:244-255.

  6. Ware LB, Matthay MA. The Acute respiratory distress syndrome. NEJM 2000;342:1334-1349.

  7. Lorraina B, Matthay A. The acute respiratory distress syndrome. N Engl J Med 2000;1334-1350.

  8. Muellenbach RM, Kredek M, Said HM, Klosterhalfer B, Zollhoefer B, Wunder C. High-frequency oscillatory ventilation reduce slung inflammation: a large-animal 24-h model of respiratory distress. Intensive Care Med 2007;33:1423-1433.

  9. Hager DN, Fessler HE, Kaczka DK, Shanholtz CB, Fuld MK, Simon BA, et al. Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2007;35:1522-1529.

  10. Fessler HE, Hager DN, Brower RG. Feasibility of very high-frequency ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2008;36:1043-1048.

  11. Cartotto RR, Walia G, Ellis S, Fowler R. Oscillation after inhalation: High frequency oscillatory ventilation in burn patients with the acute respiratory distress syndrome and co-existing smoke inhalation injury journal. BCR 2009;30:119-127.

  12. Ferguson ND, Slutsky AS. Point: high-frequency ventilation is the optimal physiological approach to ventilate ARDS patients. J Appl Physiol 2008;104:1230-1231.

  13. Fort P, Farmer C, Westerman J, Johannigman J, Beninati W, Dolan S, et al. High-frequency oscillatory ventilation for adult respiratory distress syndrome-a pilot study. Crit Care Med 1997;25:937-947.

  14. Arnold JH, Hanson JH, Toro-Figuero LO, Gutierrez J, Berens RJ, Anglin DL. Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med 1994;22:1530-1539.

  15. Bollen CW, Van Well GT, Sherry T, Beale RJ, Shah S, Findlay G, et al. High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial. Crit Care 2005;9:430-439.

  16. Demory D, Michelet P, Arnal JM, Donati S, Forel JM, Gainnier M, et al. High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation. Crit Care Med 2007;35:106-111.

  17. Derdak S, Mehta S, Stewart TE, Smith T, Rogers M, Buchman TG, et al. High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med 2002;166:801-808.

  18. Mentzelopoulos SD, Malachias S, Tzoufi M, Markaki V, Zervakis D, Pitaridis M, et al. High frequency oscillation and tracheal gas insufflation for severe acute respiratory distress syndrome. Intensive Care Med 2007;33:142.

  19. Samransamruajkit R, Prapphal N, Deelodegenavong J, Poovorawan Y. Plasma soluble intercellular adhesion molecule-1 (sICAM-1) in pediatric ARDS during high frequency oscillatory ventilation: a predictor of mortality. Asian Pac J Allergy Immunol 2005;23:181-188.

  20. Shah SB, Findlay GP, Jackson SK, Smithies MN. Prospective study comparing HFOV versus CMV in patients with ARDS. Int Care Med 2004;30:84.

  21. Hager DN, Fessler HE, Kaczka DW. Tidal volume delivery during high frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2007;35:1522–1529.

  22. Higgins JP, Thompson SG. Quantifying heterogeneity in a metaanalysis. Stat Med 2002;21:1539-1558.

  23. Sachin S, Maneesh S, Jan OF, Maureen OM, Niall DF, Hannah W, et al. High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis. BMJ 2010;340:1-11.

  24. Hamilton PP, Onayemi A, Smyth JA. Comparison of conventional and high-frequency oscillatory ventilation: oxygenation and lung pathology. J Appl Physiol 1983;55:131-138.

  25. Imai Y, Nakagawa S, Ito Y, Kawano T, Slutsky AS, Miyasaka K. Comparison of lung protection strategies using conventional and high-frequency oscillatory ventilation. J Appl Physiol 2001;91:1836-1844.

  26. Mehta S, Lapinsky SE, Hallett DC. A prospective trial of high frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2001;29:1360-1369.

  27. Hager DN, Fessler HE, Kaczka DW. Tidal volume delivery during high frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2007;35:1522-1529.

  28. Cartotto RR, Walia G, Ellis S, Fowler R. Oscillation after inhalation: High frequency oscillatory ventilation in burn patients with the acute respiratory distress syndrome and co-existing smoke inhalation injury journal. BCR 2009;30:119-127.

  29. Hager DN, Fessler HE, Kaczka DW. Tidal volume delivery during high frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2007;35:1522-1529.

  30. Imai Y, Nakagawa S, Ito Y, Kawano T, Slutsky AS, Miyasaka K. Comparison of lung protection strategies using conventional and high-frequency oscillatory ventilation. J Appl Physiol 2001;91:1836-1844.

  31. Kolton M, Cattran CB, Kent G, Volgyesi G, Froese AB, Bryan AC. Oxygenation during high-frequency ventilation compared with conventional mechanical ventilation in two models of lung injury. Anesth Analg 1982;61:323-332.

  32. Ferguson ND, Chiche JD, Kacmarek RM, Hallett DC, Mehta S, Findlay GP, et al. Combining high-frequency oscillatory ventilation and recruitment maneuvers in adults with early acute respiratory distress syndrome: the treatment with oscillation and an open lung strategy (TOOLS) trial pilot study. Crit Care Med 2005;33:479-86.

  33. Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA 2009;302:1872-1879.

  34. Fessler HE, Hager DN, Brower RG. Feasibility of very high-frequency ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2008;36:1043-1048.

  35. Muellenbach RM, Kredek M, Said HM, Klosterhalfer B, Zollhoefer B, Wunder C. High-frequency oscillatory ventilation reduces lung inflammation: a large-animal 24-h model of respiratory distress. Intensive Care Med 2007;33:1423-1433.




2020     |     www.medigraphic.com